The Van Gorder approach for total elbow arthroplasty

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Surgical Techniques

Background:

• Surgical management of the triceps is crucial for total elbow arthroplasty (TEA) success.
• The Van Gorder approach offers complete joint visualization without disrupting the triceps insertion.
• This technique, described in 1933, has limited evaluation in the literature for TEA.

Purpose of the Study:

• To evaluate the outcomes of the Van Gorder approach in a large series of patients undergoing primary TEA.
• To assess the efficacy and safety of this specific surgical technique for elbow replacement.
• To compare outcomes with existing methods for triceps management in TEA.

Main Methods:

• Retrospective review of 53 patients undergoing primary TEA via the Van Gorder approach (2008-2016).
• Inclusion criteria: at least 6 months follow-up; exclusion: prior elbow surgery.
• Data collected: demographics, indications, range of motion, triceps function, reoperations, VAS, and QoL scores.

Main Results:

• Average follow-up was 30.2 months in 53 patients (mean age 62, 81% female).
• Common indications: inflammatory arthritis (47%), osteoarthritis (24%), fracture (19%).
• Postoperative motion: 8°-137°. Triceps failure: 1.89%. Reoperations: 19% (mostly wound complications). Significant VAS score reduction observed.

Conclusions:

• This study represents the largest evaluation of the Van Gorder approach for primary TEA.
• Outcomes, including triceps failure and reoperation rates, are comparable to other established TEA surgical methods.
• The Van Gorder approach is a viable option for achieving excellent exposure in total elbow arthroplasty.