Overview of Expandable Stem Radial Head Arthroplasty Procedure

The types of prosthetics used at the radial head joint for an RHA procedure are meant to help take the place of the radial head that’s no longer able to be repaired or reconstructed.

RHA is usually recommended if the radial head has been fractured where it meets the elbow joint and other types of treatments — such as physical therapy or corticosteroid injections — haven’t worked.

The expandable stem device used in this type of RHA has an extra benefit — the prosthesis stem that extends into radius bone can be lengthened using an external key device.

This can help the surgeon make adjustments to the length of the prosthesis to ensure that there isn’t any shortening of the bone after surgery. It’s especially beneficial for young children who undergo RHA and need the prosthesis to be extended to keep the arm growing at a natural rate.

It’s possible that the prosthesis used in RHA may not fit properly because the surgeon didn’t choose the right size or because the prosthesis simply doesn’t fit well into the radius bone.

This risk can increase if the surgeon doesn’t have enough bone to use as a guide for the procedure. An older 2012 study also suggests that bone can grow back in places it isn’t supposed to grow.

Some other risks of all RHA procedures include:

• losing the ability to fully move your elbow joint
• pain when you move your elbow joint
• stiffness and pain after the procedure
• the prosthesis becoming loose in the joint
• infection in the joint or surrounding tissues
• instability in the elbow joint
• numbness around the joint
• redness and swelling where the surgery was done
• developing osteoarthritis in the joint

Here’s what will usually happen before, during, and after an expandable stem RHA.

Before the procedure

You may need to stop taking blood thinners a few days before the surgery. You may also be asked to fast for 12 hours before the surgery, but you should be able to drink water.

You may want to adjust your living and working areas so that you can continue doing your daily tasks while your arm is healing. If it’s possible, take some time off so that you can rest and heal.

On the day of the procedure, you’ll visit a hospital or medical facility and get the procedure done in 1 day. You’ll usually be able to go home shortly after the procedure is complete. Someone should be available to help you get to and from the procedure.

During the procedure

You’ll be given general anesthetics so that you’re in a sleep-like state of nonfeeling.

The surgeon will:

1. Cut an incision in the skin above the elbow joint near the radial head.
2. Remove parts of the radial head or nearby bone that’s damaged or injured so that the prosthesis fits.
3. Use a tool to make a large opening into the radius bone that the prosthesis will fit into.
4. Measure the pieces left from your radial head to size the prosthesis properly for the joint.
5. Put in the prosthesis and check that it fits properly into the bone.
6. Ensure that the expandable stem can be adjusted with a key that can be used near where the prosthesis meets the joint.
7. Suture ligaments around the joint with dissolvable sutures.
8. Use stitches to close up the incision.

The surgeon may order X-rays to check that the prosthesis fits properly into the joint and bone.

After the procedure

When you wake up in the recovery room, the care team will check that your breathing and heart rate are stable. Then, they’ll put your arm into a sling or splint to help keep it from moving.

Here are some instructions you might receive for taking care of yourself for the next few weeks:

• Reduce swelling around the surgical site with a cold compress.
• Use over-the-counter (OTC) medications like ibuprofen for pain.
• Elevate your elbow so that blood drains from the area.
• Avoid using your arm so the joint can heal.
• Avoid bathing or swimming until the doctor removes your splint or sling.
• Follow the surgeon’s instructions about how to move your wrist, fingers, elbow, and arm to keep your range of motion without injuring the joint.

The doctor will remove your sling or splint about 1 to 3 weeks after surgery. You can then start physical therapy, but you’ll need to be careful resuming any strenuous activities unless you’ve been given approval to do so.

Full recovery from an expandable stem RHA takes about 3 to 6 months.

You’ll likely be instructed to do physical therapy during this period. This will help you learn how to move your joint using the new prosthesis and restore as much range of motion as possible.

Recovery may be affected by:

• the level of radial head damage before the surgery
• how closely you’re able to follow the doctor’s instructions during your recovery
• rejection of the prosthesis

Like other types of RHA, expandable stem RHA is typically successful at restoring range of motion and reducing pain or stiffness in the joint.

RHA prosthetics are known to loosen over time depending on how well they fit into the joint and bone.

A 2016 study suggests that expandable stem prosthetics have a much lower risk of coming loose because of how deeply and tightly the expandable stem fits into the radius bone. This risk is even lower if there’s still a lot of bone left in the joint after the procedure.

RHA prosthetics are more likely to loosen if they’re knocked around by strenuous activity or heavy, repeated impact to the elbow or surrounding bones.

The prosthetics used in expandable stem RHA often last for years. Although there’s no research focused specifically on this type of RHA prosthesis, the outlook for people who have undergone RHA is usually good.

A 2016 review looked at studies of RHA procedures done between 1940 and 2015, including those that involved expandable stem prosthetics. The reviewers found that only about 8% of people who received RHA needed to have follow-up surgery or repairs to the prosthesis.

Other research has supported RHA as a generally successful treatment.

A small 2018 study followed 32 people who received RHA. No one involved in the study needed their prosthetics to be repaired or replaced for up to 15 years after the procedure.

A 2019 study followed 119 people who underwent RHA. About 25% needed to have their prosthetics fixed or removed in the 7 to 12 months after RHA.

People who have fractured or damaged the radius may need RHA if other treatments aren’t enough to restore range of motion or reduce pain and stiffness.

People with osteoarthritis or rheumatoid arthritis may also need RHA if the joint tissues and bones have worn down enough to need extensive repair or reconstruction of the joint.

RHA may also be used to treat joints that have worn down due to Ehlers-Danlos syndrome (EDS). In EDS, your body doesn’t produce enough collagen to keep your joint tissue stable. RHA can help increase stability in the joint but may require longer recovery time and more physical therapy.

On average, the cost of RHA can range from $11,000 to $13,000. With insurance, this cost is likely to be reduced to between $1,100 and $2,000.

RHA is typically covered by government health insurance programs like Medicare or Medicaid.

The amount you pay after insurance may include:

• your coverage
• the facility where the procedure is done
• the materials used in the expandable stem device

RHA is often successful at allowing your elbow joint to regain range of motion and mobility after an injury or damage from arthritis or other conditions.

An expandable stem RHA is especially useful for long-term effectiveness and ensuring that bones can grow properly long after the procedure. Following your instructions for aftercare and physical therapy can help you ensure the best possible results.