The Van Gorder Approach for Total Elbow Arthroplasty.

Abstract

BACKGROUND\nSurgical management of the triceps during exposure for total elbow arthroplasty (TEA) is critical to a successful outcome. Previously described techniques include elevating the triceps insertion from one side, or leaving the triceps insertion attached and dislocating the joint. Another approach to the elbow, first described in 1933 by Willis Campbell, MD and subsequently modified by George Van Gorder, MD, involves turning down the triceps tendon without disrupting the triceps insertion. This approach offers complete visualization of the joint and provides excellent exposure for total elbow arthroplasty. Only the original report of the technique and a small series of patients using this technique for TEA exists in the literature. The goal of this study was to evaluate outcomes of the Van Gorder approach in a large series of patients undergoing TEA.\n\n\nMETHODS\nAll patients who underwent total elbow arthroplasty from 2008 to 2016 were retrospectively reviewed. Only patients who underwent primary TEA performed through the Van Gorder approach with at least 6 months follow-up were included for analysis. Patients with prior elbow surgery were excluded. Demographic data, indication for surgery, postoperative range of motion, triceps function, and need for additional surgery, were recorded. Prospectively collected Visual Analog Scores (VAS), and Global Health Quality of Life (GHQoL) scores were also analyzed.\n\n\nRESULTS\nA total of 53 patients met inclusion criteria. Average age was 62 years, 81% were female, and the average follow-up was 30.2 months. The most common surgical indications included inflammatory arthritis (47%), osteoarthritis (24%), and fracture (19%). Postoperatively, average elbow arc of motion was an 8 to 137 degree. There was 1 patient (1.89%) who developed failure of their triceps extension mechanism. A total of 10 patients (19%) underwent additional elbow surgery most commonly for superficial wound complications. Preoperative VAS scores decreased significantly starting at 3 months postoperatively (6.76 to 3.37, p < 0.001), and remained constant at the 12 and 24-month postoperative visits.\n\n\nCONCLUSIONS\nThis is the largest study evaluating the Van Gorder surgical approach to the elbow for primary total elbow arthroplasty with an average follow-up of 32 months. Overall rates of triceps failure and reoperation are consistent with other approaches for total elbow arthroplasty.