[Arthrodesis of the trapeziometacarpal joint].

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Abstract

[Indexed for MEDLINE] 9. JBJS Rev. 2021 Jul 16;9(7). doi: 10.2106/JBJS.RVW.20.00281. Triceps Insufficiency After Total Elbow Arthroplasty: A Systematic Review. Meijering D(1), Welsink CL(2), Boerboom AL(1), Bulstra SK(1), Vegter RJK(3), Stevens M(1), Eygendaal D(4)(5), van den Bekerom MPJ(6)(7). Author information: (1)Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. (2)Department of Orthopedic Surgery, Isala Klinieken, Zwolle, the Netherlands. (3)Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. (4)Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands. (5)Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands. (6)Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands. (7)Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands. BACKGROUND: The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS: We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS: Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS: The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.RVW.20.00281