Total elbow arthroplasty is often indicated in patients with fragile bone and soft tissues, such as those with rheumatoid arthritis. Some of the techniques for elbow arthroplasty involve partial or complete detachment of the triceps from the proximal ulna. In these instances, triceps failure can occur, presenting a particular problem for those who need triceps function to get out of a chair or for ambulation.
To minimize the risk of triceps failure following elbow arthroplasty, we have implemented a simple, yet extensive “triceps-on” approach to the elbow and demonstrated its application to total elbow arthroplasty.
The skin incision runs over the ulnar nerve, which is dissected free from the ulna and the medial capsule. Through this single skin incision, a complete 360-degree capsular release is performed through medial and lateral approaches. The ulna is then gently dislocated laterally with the triceps attached to the olecranon, allowing a semiconstrained total elbow prosthesis to be implanted.