The Lateral Para-Olecranon Approach for Total Elbow Arthroplasty

PURPOSE: To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches. METHODS: A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases. RESULTS: Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 ± 8 N-m) compared with the triceps splitting (13 ± 4 N-m) or paratricipital approaches (12 ± 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups. CONCLUSIONS: The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.