A press-fit radial head arthroplasty is a procedure that helps restore the function of the head of your radius bone, one of the long arm bones that connects your forearm to your elbow joint and allows you to turn your palm up or down.
Radial head arthroplasty (RHA) is done by using a prosthetic insert that’s pressed into your radius bone to anchor the prosthetic in place, help your joint move freely, and serve as a replacement radial head.
Read on to learn more about when this procedure can be beneficial, how it’s done, and what results you can expect.
Press-fit RHA prosthetics can help reduce pain and restore range of motion in your elbow joint when damage is so severe that it can’t be repaired by nonsurgical treatments like physical therapy or corticosteroid injections.
RHA is often recommended when your radial head is fractured in a manner that it can’t be fixed or is in too many pieces (this is called comminution).
One of the most common risks of a press-fit RHA is the prosthetic not being sized properly for your elbow joint. This is more likely if there’s a lot of damage to your joint and there isn’t much bone left for the surgeon to refer to when creating your prosthesis. It can lead to pain, decreased range of motion, and limited function.
Loosening of your prosthesis is also common. In a small 2021 study of 25 people who underwent press-fit RHA, eight had loosening of their prosthesis and some needed it removed due to pain or infection.
Other risks of RHA include:
- losing range of motion in your elbow
- pain or stiffness in your elbow
- infection at the surgery site
- not having full stability in your joint
- numbness or tingling around your joint
- redness or swelling around your joint
- developing osteoarthritis in your joint
Here’s what you need to know about what happens before, during, and after a press-fit RHA procedure.
Before the procedure
Here are some tips to prepare for a press-fit RHA:
- Ask someone to take you to and from the procedure: You can usually go home the same day.
- Plan to skip daily activities for a few days: You won’t be able to fully use your arm for a few weeks.
- Make your home comfortable: You’ll need to get around with limited use of your arm.
- Stop taking medications: Medications like blood thinners will need to be stopped several days before the procedure. Check with a doctor or healthcare professional on whether to continue some medications.
- Fast: Don’t eat or drink liquids other than water for 12 hours before your procedure.
During the procedure
Under general anesthesia, the surgeon will:
- Cut into your skin above your elbow joint.
- Take out damaged pieces of your radial head or nearby bone.
- Shape the bone around your connecting bone (radial neck) to make way for the prosthesis.
- Use a tool to make a hole in your radius bone for the prosthesis to fit into.
- Measure your damaged radial head as a template to decide which size prosthesis to use.
- Press the prosthesis stem into your radius bone and fit it snuggly.
- Repair ligaments or tissues around your radial head with sutures.
- Use stitches to close up your skin.
The surgeon may also take X-rays to check the fit of your prosthesis.
After the procedure
When you wake up, your care team will monitor your vital signs in a recovery room until you’re considered stable enough to go home. You’ll have your arm put into a sling or splint.
For the first few days after surgery, you’ll:
- treat swelling with a cold compress
- relieve pain with over-the-counter (OTC) medications like ibuprofen
- raise your elbow when you’re resting so that blood drains from the surgery site
- avoid using your affected arm so the joint can heal
- avoid getting your sling or splint wet until the doctor says it’s allowed
- slowly begin using your arm, starting with your fingers and wrist, to regain range of motion
Your splint or sling will be removed after about 1–3 weeks. Then you’ll need a few months of physical therapy before you can resume normal activities, including strenuous and athletic activities.
Here’s an X-ray image of a press-fit RHA.
You’ll need between 1 and 3 weeks of recovery before your splint or sling is removed. Physical therapy will usually take about 3–6 months to restore your full range of motion and reduce pain from the prosthesis.
Some factors that can affect your recovery time include how:
- much your joint or bone was injured or worn down
- the prosthesis fits into your joint
- much you rest the joint during your recovery
- your body responds to the prosthesis
- closely you follow your physical therapy plan
- well your body responds to pain control measures to allow for motion
Despite risks and complications, such as pain or loosening of the prosthesis, press-fit RHA is often successful in helping restore range of motion in your elbow joint, especially for complex fractures.
An older 2016 study found that having a large amount of bone left in your joint can help prevent the prosthesis from loosening or failing.
A 2022 study of 16 older people who underwent press-fit RHA found that about 81% of the prosthetics were successful, with three of the press-fit RHA prosthetics removed.
Press-fit RHA is done when nonsurgical treatments can’t help reduce your pain or restore range of motion in your elbow joint.
If your bone quality is poor, you may be a better fit for a cemented RHA.
RHA can also be used when your elbow joint is worn down due to a lack of sufficient collagen, a type of protein, to support the connective tissues in your elbow joint that’s caused by Ehlers-Danlos syndrome (EDS). EDS can cause your joint and radial head to get damaged. RHA can reduce instability and pain that may happen as a result.
Press-fit RHA costs about
Press-fit RHA is also covered by Medicare and Medicaid.
RHA is often successful in treating radial head injuries or joint damage from arthritis that affects your nearby bones.
The key to recovery is restoring the range of motion of your elbow joint after the procedure. It’s best to follow your aftercare or physical therapy instructions closely.