Introduction: Total Elbow Arthroplasty (TEA) has become a useful tool in combatting both chronic and acute elbow pathology. Unfortunately, complication rates remain as high as 25%. A rare, but devastating complication is extensor insufficiency. In an attempt to mitigate this risk, various TEA techniques have been described. We describe here a triceps sparing approach to TEA that limits the risk of extensor insufficiency and provides increased intraoperative exposure by detaching the collateral ligaments distally from their radial and ulnar components. We hypothesize that this technique will result in an extensor complication rate equal to or less than other triceps sparing approaches, while providing excellent surgical exposure leading to improved patient centered and radiographic outcomes.

Methods: A retrospective review was completed at a single surgeon community-based institution. 17 patients were included in the study. Elbow functionality was recorded using range of motion criteria. Post-operative implant loosening was determined using both clinical reasoning and radiographic data. All surgical and postoperative complications were recorded, notably intraoperative fracture, need for revision, reoperation, septic/aseptic loosening, triceps insufficiency, infection, and neuropathy. Outcomes were measured pre- and post-operatively at the most recent follow-up appointment.

Results: Only one patient (5.9%) suffered from implant loosening requiring revision, versus the average rate of 10-25%. A statistical increase across all ROM categories was recorded. Overall complication rate was consistent with the literature value of 29%. Only one patient experienced significant hardware failure, periprosthetic fracture, and triceps pathology, and this was due to a post-operative fall leading to an olecranon fracture. When excluding this individual, our complication rates for revision, infection, and triceps insufficiency were all well below the rate of similar studies. We did experience higher ulnar neuropathy complications than most studies (11.8%), but the small sample size likely skews this value.

Conclusions: TEA has developed into a suitable solution to both traumatic and chronic elbow pathology. TEA utilizing the distal collateral ligament detachment technique allows great intraoperative exposure, improved post-operative patient oriented and radiographic values, and limits the complications associated with TEA. This technique could serve as an asset to any orthopedic surgeon performing TEA.