A modified posterior approach to the elbow for total elbow replacement

Fifty-nine consecutive primary total elbow replacements were performed with the modified posterior approach. The approach differs from other described approaches. The fascia and periosteum over the subcutaneous border of the ulna are preserved, and dissection is carried out on either side of the ulna. This enables a more secure repair of the posteromedial and posterolateral muscle compartments. The ulnar nerve is mobilized to prevent any injury. The distal humerus and proximal ulna can be fully exposed by this approach, giving wide access so necessary for accurate positioning of the prosthesis. The overall complication rate in 59 total elbow replacements was 33.9% including 4 (6.7%) ulnar nerve palsy, 4 (6.7%) wound infections, 2 (3.3%) delayed healing, 4 (11.8%) diminished range of motion in the affected elbow, 2 (3.3%) instability (1 had dislocated elbow and 1 had subluxation), and 1 (1.7%) triceps dehiscence requiring exploration and repair. All the patients could perform active resisted extension of the elbow, indicating continuity of the triceps. The senior author (SCG) has been using this approach for the Roper-Tuke unconstrained total elbow replacement for the last 15 years, and it has been associated with a lower incidence of complications. This approach has not been described before and is recommended for total elbow replacement.