Background: Total elbow arthroplasty (TEA) is indicated for patients with elbow arthritis that have exhausted nonsurgical management and can be performed through multiple surgical approaches. However, it is not clear if and which approach is superior. The objective of this systematic review is to evaluate recent TEA literature in the United States to compare the clinical outcomes for the triceps-splitting and triceps-reflecting approaches.
Methods: Querying PubMed, Embase, Web of Science, and CINAHL, a systematic review was conducted on total elbow arthroplasty and its outcomes for the triceps-splitting and triceps-reflecting approaches. Inclusion criteria were studies published from 2004 to 2024 that addressed clinical outcomes for triceps approaches. Studies were excluded if duplicates, from non-United States, published beyond the past 20 years, lacking TEA approaches, lacking clinical outcomes, cadaver or animal studies, or unavailable in English full texts.
Results: A total of 25 studies involving 2,393 elbows across 2,382 patients were included in this systematic review. The triceps-splitting approach was used in 777 elbows across 11 studies, whereas the triceps-reflecting approach was applied to 1,618 elbows in 14 studies. The triceps-reflecting approach demonstrated a greater change in Mayo Elbow Performance Scores, from a mean of 34.9 preoperatively to 78.2 postoperatively (triceps-splitting: 48.8-79). Both approaches showed notable improvement in all metrics of range of motion (ROM), but higher-quality studies showed trends of favoring the triceps-reflecting approach for greater increases in ROM. Furthermore, the complication rate was higher in the triceps-splitting group (31.2%) compared with the triceps-reflecting group (17.7%).
Conclusion: The triceps-reflecting approach of TEA suggests notable improvements in Mayo Elbow Performance Scores and ROM, with potentially lower complication rates than the triceps-splitting approach. More quality research is also needed on other triceps approaches.
Level of evidence: Level IV, systematic review of Level II to IV studies.
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