Overview of Cemented Radial Head Arthroplasty Procedure

Prosthetics can be put into the head of the radius bone where it meets the elbow joint to replace a damaged or worn down radial head. It’s considered an effective procedure in cases for which less invasive treatments like corticosteroid injections or physical therapy aren’t effective.

RHA is especially preferred if you have a complex fracture in your elbow joint that affects the radial head or if the elbow joint is dislocated and can’t easily be put back in place to restore your full range of motion.

It’s possible that the prosthesis used to replace the radial head might not fit properly if you don’t have much bone left in your radial head that the surgeon can use as an example to customize your prosthesis.

Some other risks of RHA include:

• losing some of your original range of motion, including the ability to extend your arm all the way
• pain when you move your elbow
• stiffness
• feeling unstable when you try to use your elbow
• the prosthesis coming loose from the bone or the joint
• numbness or tingling near the elbow joint
• redness and inflammation at the surgery site
• infection at the surgery site
• osteoarthritis developing in the joint
• allergic reaction to dye used in the cement

Here’s what you can expect.

Before the procedure

This outpatient procedure usually takes place in 1 day at a hospital or medical facility.

Beforehand, you’ll be asked to:

• Stop taking blood thinners.
• Take 1 to 2 days off to rest and heal.
• Adjust your living and working spaces to help you do regular activities.
• Plan ahead to have someone drive you to and from the procedure.
• Have someone available to help you with daily tasks at home for a few weeks. You can also ask the medical team for home care recommendations.
• Avoid eating or drinking for 12 hours before the surgery. Ask the doctor if it’s OK to drink water.

During the procedure

To perform an RHA, the surgeon will do the following while you’re under general anesthesia:

1. Cut through the skin above the elbow joint to get to the radial head.
2. Take out damaged pieces of the radial head and neck. These pieces will be used to model and shape the prosthesis.
3. Use a cutting tool to make a hole in the radius bone.
4. Insert the prosthesis into the bone, with a stem going into the radius bone that’s cemented in place to keep it from moving.
5. Remove excess cement from the bone to ensure a proper fit.
6. Repair the ligaments and tissues of the joint with sutures.
7. Close and stitch up the cut in the skin.

X-rays will also be done so that the surgeon can check that the prosthesis fits properly.

After the procedure

Once you wake up, you’ll be in a recovery room with a care team checking your breathing and heart rate until you’re stable enough to go home. They’ll put a sling or splint on your arm before you leave.

Here’s what you’ll need to do for the first few days:

• Relieve inflammation with a cold compress.
• Reduce pain with over-the-counter (OTC) medications like ibuprofen.
• Lift your elbow as much as possible to keep blood draining from your elbow joint.
• Avoid lifting anything.
• Avoid getting your sling or splint wet until the doctor says you’re OK to do so.
• Slowly introduce movement back into your wrist, hand, fingers, and elbow so that you can ease back into your full range of motion.

It’ll take about 1 to 3 weeks to recover from surgery. Then, you’ll do physical therapy for up to 6 months to help restore range of motion.

Don’t do strenuous or athletic activities until you’re done with physical therapy so that you don’t reinjure yourself or damage your prosthesis.

Here’s what your elbow joint will look like after a cemented RHA procedure:

You’ll probably get your sling or splint off after 2 weeks. You’ll need about 3 to 6 months of physical therapy, and you’ll need to ease back into regular activities until your joint is fully recovered.

Some factors that can affect your recovery time include:

• how much injury or damage was done to your elbow joint
• what kind of prosthesis was used
• how closely you’re able to follow your aftercare instructions
• what side effects you experience after the procedure, which can include your body rejecting the prosthesis

A small 2016 study of 25 people who underwent a cemented RHA found that only one person needed any correction after surgery. Two people experienced issues due to errors by the radiologists who performed imaging tests.

The prosthesis can loosen or become damaged if you’re physically active or experience a lot of impact injuries after the procedure. Loosening is somewhat common, but it doesn’t necessarily affect how well you can use your joint.

A 2018 study followed a small sample of 32 people who underwent RHA. None of the people who participated in the study reported that they needed their prosthetics repaired or replaced in follow-ups conducted 7 to 15 years after surgery.

A 2019 study that followed 119 people who underwent RHA found that about 25% of the participants needed some kind of repair or prosthetic removal up to a year after RHA.

Cemented RHA is usually best when the radial head or elbow joint can’t be treated by steroid injections or physical therapy. It’s a possible treatment for osteoarthritis and rheumatoid arthritis when the elbow joint is affected.

Cemented RHA can also help restore joints that have been worn down as a result of Ehlers-Danlos syndrome (EDS). With this condition, your body may not make enough collagen to support your joints as they wear out with use and age.

Cemented RHA costs about $11,000 to $13,000 before insurance coverage.

You’ll probably pay between $1,100 and $2,000 after insurance. It’s also covered by Medicare and Medicaid.

RHA can help heal damage to the radius bone head after an injury or due to arthritis.

After RHA, follow the surgeon’s instructions closely to help make sure you heal properly. And try your best to follow your physical therapy plan so that you can regain as much range of motion as possible.