Background: The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice.Methods: We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included $6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year.Results: Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. Conclusions:The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes.
Background The aim of this study was to review the long-term results of the instrumented Bone Preserving (iBP) elbow prosthesis. Methods Thirty-one patients (10 M, 21F, 28-77 year) were retrospectively evaluated using the Oxford Elbow Score (OES), Disabilities of Arm, Shoulder and Hand Outcome Measure (DASH), Mayo Elbow Performance (MEPS), physical examination and standard radiographs. Kaplan-Meier survival analysis was used. Results Thirty-seven primary iBPs have been placed in 31 patients between 2000 and 2007. Six patients (8 prostheses) had died, 10 elbows had been revised and three patients (4 prostheses) were lost to follow-up. Fourteen patients (15 prostheses) were available for follow-up. The main indication for surgery was rheumatoid arthritis. Mean follow-up was 11 years (8–15). Kaplan-Meier survival analysis showed a survival of 81% at 10 years after surgery. Main reason for revision was particle disease and loosening due to instability and malalignment. Eleven of 14 patients were satisfied, although radiographs showed radiolucencies in 11 patients. Conclusion The iBP elbow prosthesis gives a survival rate of 81% 10 years after surgery with a progressive decline beyond 10 years. However, many patients have radiolucencies. Discrepancy between clinical signs and radiological results warrants structural follow-up, to assure quality of bone stock in case revision surgery is indicated. The study was reviewed and approved by the Medical Ethical Committee of University Medical Center Groningen (METc2016/038). Level of evidence Level IV, Case series.
BackgroundNew surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA.Methods and analysisA multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications.DiscussionThe successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA.Ethics and disseminationThe Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544).Trial registration numberNTR NL8488.
Background Overloading is hypothesized to be one of the failure mechanisms following total elbow arthroplasty (TEA). It is unclear whether the current post-operative loading instruction is compliant with reported failure mechanisms. Aim is therefore to evaluate the elbow joint load during activities of daily living (ADL) and compare these loads with reported failure limits from retrieval and finite element studies. Methods A scoping review of studies until 23 November 2021 investigating elbow joint load during ADL were identified by searching PubMed/Medline and Web of Science. Studies were eligible when: (1) reporting on the elbow joint load in native elbows or elbows with an elbow arthroplasty in adults; (2) full-text article was available. Results Twenty-eight studies with a total of 256 participants were included. Methodological quality was low in 3, moderate in 22 and high in 3 studies. Studies were categorized as 1) close to the body and 2) further away from the body. Tasks were then subdivided into: 1) cyclic flexion/extension, 2) push-up, 3) reaching, 4) self-care, 5) work. Mean flexion–extension joint load was 17 Nm, mean varus-valgus joint load 9 Nm, mean pronation-supination joint load 8 Nm and mean bone-on-bone contact force 337 N. Conclusion The results of our scoping review give a first overview of the current knowledge on elbow joint loads during ADL. Surprisingly, the current literature is not sufficient to formulate a postoperative instruction for elbow joint loading, which is compliant with failure limits of the prosthesis. In addition, our current instruction does not appear to be evidence-based. Our recommendations offer a starting point to assist clinicians in providing informed decisions about post-operative instructions for their patients.
Background The number of complications after total elbow arthroplasty (TEA) is high and survival rates are low compared to hip and knee arthroplasties. The most common reason for revision is aseptic loosening, which might be caused by overloading of the elbow. In an attempt to lower failure rates, current clinical practice is to restrict activities for patients with a TEA. However, postoperative management of TEA is a poorly investigated topic, as no evidence-based clinical guidelines exist and the aftercare is often surgeon-based. In this study we evaluated the current postoperative management of TEA among orthopedic surgeons. Methods An online survey of 30 questions was sent to 635 members of the European Society for Surgery of the Shoulder and the Elbow (SECEC/ESSSE), about 10% (n = ± 64) of whom are considered dedicated elbow specialists. The questions were on characteristics of the surgeon and on the surgeon’s preferred postoperative management, including items to be assessed on length of immobilization, amount of weight bearing and axial loading, instructions on lifelong activities, physiotherapy, and postoperative evaluation of the elbow. Results The survey was completed by 54 dedicated elbow specialists from 17 different countries. Postoperative immobilization of the elbow was advised by half of respondents when using the triceps-sparing approach (52%), and even more with the triceps-detaching approach (65%). Postoperative passive movement of the elbow was allowed in the triceps-sparing approach (91%) and in the triceps-detaching approach (87%). Most respondents gave recommendations on weight bearing (91%) or axial loading (76%) by the affected elbow, but the specification shows significant variation. Conclusion The results from this survey demonstrate a wide variation in postoperative care of TEA. The lack of consensus in combination with low survival rates stresses the need for clinical guidelines. Further research should focus on creating these guidelines to improve follow-up care for TEA.
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