Triceps insufficiency following total elbow arthroplasty

Background: Over the past decade, the indications for total elbow arthroplasty have increased. One complication that is well recognized but is poorly described in the literature is insufficiency of the extensor mechanism involving complete or partial rupture, or avulsion, of the triceps tendon. We therefore reviewed the records of patients who had undergone surgery for the treatment of triceps insufficiency following total elbow arthroplasty to determine the management options and outcomes of intervention for this problem. Methods: The records on 887 total elbow arthroplasties performed between 1982 and 2001 were assessed to identify patients who had undergone a subsequent procedure on the triceps. Patients in whom triceps insufficiency developed after debridement for infection were excluded, leaving sixteen elbows in fourteen patients. A Mayo Elbow Performance Score was calculated and elbow extension strength against gravity was measured at the time of final follow-up. Results: There were seven male and seven female patients. The mean age was fifty-four years. The mean duration of follow-up after the triceps reconstruction was sixty-seven months. Three basic techniques were used to repair or reconstruct the extensor mechanism; these included direct suture in seven elbows, anconeus rotation in four, and use of an Achilles tendon allograft in four. The capacity to extend against gravity was restored to fifteen of the sixteen elbows. According to the Mayo Elbow Performance Score, eleven elbows had an excellent outcome, three had a good outcome, and two were considered a clinical failure. Conclusions: In most patients with triceps insufficiency following total elbow arthroplasty, it is possible to reconstruct the triceps mechanism with a procedure appropriately selected on the basis of tissue quality, tendon retraction, and the status of the olecranon. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.