A modified posterior approach to the elbow for total elbow replacement

Area of Science:

• Orthopedic Surgery
• Surgical Approaches
• Arthroplasty

Background:

• Total elbow replacement is a complex procedure requiring optimal surgical access.
• Existing posterior approaches may have limitations in exposure and muscle repair.
• Minimizing complications is crucial for successful total elbow arthroplasty outcomes.

Purpose of the Study:

• To describe a novel modified posterior surgical approach for primary total elbow replacement.
• To evaluate the safety and efficacy of this approach in a consecutive series of patients.
• To compare the complication rates with previously reported methods.

Main Methods:

• A modified posterior approach was utilized in 59 consecutive primary total elbow replacements.
• Key modifications include preserving fascia and periosteum over the ulna for enhanced muscle repair.
• The ulnar nerve was mobilized, and wide exposure of the distal humerus and proximal ulna was achieved.

Main Results:

• The overall complication rate was 33.9%, with specific complications including ulnar nerve palsy (6.7%), wound infections (6.7%), and instability (3.3%).
• All patients maintained active resisted elbow extension, indicating triceps continuity.
• The senior author has used this approach for 15 years with a perceived lower complication incidence.

Conclusions:

• The modified posterior approach provides excellent exposure for total elbow replacement.
• Preservation of periosteum and fascia allows for secure muscle compartment repair.
• This novel approach is recommended for total elbow arthroplasty, potentially reducing complications.