A radial head arthroplasty (RHA) is done to replace or repair part of the radius bone, a long bone that connects your elbow to your wrist, with a prosthetic insertion at its “head” where it joins with your elbow joint.

A radial head arthroplasty (RHA) may be done if you have instability in the elbow joint, if arthritis has worn away at the joint and is causing your pain and difficulty moving your arm, or if the radial head was fractured in a trauma and can’t be fixed. One of three types of prosthetics may be used:

  • press-fit
  • cemented
  • loose fit
  • expandable stem

Read on to learn more about when this procedure can be beneficial, how the procedure is done, and what you can expect after you have this procedure done.

The use of prosthetic insertions into the joint at the radial head can help in cases in which the bone is injured to the point that it can’t be repaired or reconstructed.

RHA is a preferred treatment in scenarios of a fracture to the elbow joint where it connects to the radius and in cases in which physical therapy, corticosteroid injections, or other nonsurgical treatments haven’t helped reduce pain or stiffness in the joint.

The biggest risk is the prosthesis not being sized correctly or not fitting well into the radius.

This risk is much higher if there’s not enough bone left at the radial head to use as a reference for rebuilding the joint with prosthetics or if, according to a 2012 study, tissue like muscle contracts around the joint.

Some possible risks of RHA can include:

  • decreased range of motion, such as the inability to fully extend your elbow joint
  • pain with range of motion
  • continued pain or stiffness in the joint
  • loosening of the prosthetic insertions
  • infection around the surgical site
  • continued instability in the joint
  • feeling numb around the joint
  • swelling or redness near the surgical site
  • development of osteoarthritis in the joint

Here’s what you can expect from RHA before, during, and after the procedure.

Before the procedure

This procedure is usually done in a medical facility or hospital in a single day. You may be able to go home on the same day as the procedure.

You may be asked to stop taking certain medications, such as blood thinners, a few days before your procedure. You may also have to stop eating and drinking up to 12 hours before the surgery, but you may be allowed to keep drinking water.

Be sure to ask a friend or family member to take you to and from the procedure. Your arm will be in a splint or sling after the procedure, and you won’t be able to drive or do some daily tasks for a couple of weeks.

Try to set up your living space and working space to accommodate you while your arm heals. If you can, take a few weeks off work or other responsibilities so that you can rest your arm.

During the procedure

An RHA is performed under general anesthesia. Here’s what the surgeon will do to perform the procedure:

  1. Make a cut through the skin over the elbow joint where the radial head is located.
  2. Remove any pieces of the radial head or the connecting bone (the radial neck).
  3. Cut away pieces of the radial neck to make it easier to fit the prosthetic insertion.
  4. Push an awl (a tool that makes holes) into the radius bone to make way for the prosthesis.
  5. Use the leftover pieces of the radial head to measure the radial head for the prosthesis.
  6. Insert the prosthesis carefully to make sure it fits properly and isn’t too big for the bone.
  7. Make any needed repairs to the surrounding ligaments with sutures.
  8. Close up the cut in the skin with stitches.

Additionally, X-rays may be taken to confirm the proper insertion of the prosthesis.

After the procedure

After the procedure, you’ll wake up in a recovery room. Once your care team confirms that your vital signs — including your breathing and heart rate — are stable, your arm will be put into a splint or sling.

Once you go home, here’s what a doctor may tell you to do in the first few days:

  • Use a cold compress to relieve swelling around the area.
  • Take over-the-counter (OTC) pain medications, such as ibuprofen, to help relieve pain.
  • Keep your elbow elevated so that blood doesn’t pool around the joint.
  • Use your arm as little as possible to let the joint heal.
  • Don’t bathe, shower, or swim with your splint or sling on until the doctor confirms you can do so.
  • Follow the surgeon’s instructions as to when you can move your arm, fingers, and wrist around again to bring some motion back to the joint.

Once your sling or splint is removed about 1 to 3 weeks later, you may start physical therapy. You may need to continue refraining from activities such as sports until you complete therapy.

Here’s what you can expect to see on an X-ray after a successful RHA:

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Photography courtesy of Kodde IF, Viveen J, The B, van Riet RP, Eygendaal D. Management of the failed radial head arthroplasty. EFORT Open Rev. 2020 Aug 1 (CC BY-NC 4.0).

On average, it takes about 2 weeks before you can have your sling or splint removed. Once you start physical therapy, you’ll usually recover after 3 to 6 months of therapy and adjustment to your new joint prosthesis.

The time it takes to recover from RHA depends on:

  • how extensive the injury or damage was to your bone or joint before the procedure
  • the type of prosthetic insertion used
  • how well you take care of your elbow after the procedure
  • whether your body accepts the prosthetic insertion

Radial head replacement is usually successful. Some loosening of the prosthesis can happen depending on the type of prosthesis chosen and how well it fits into the bone.

Press-fit prosthetics are most likely to loosen over time. A 2016 study suggests that this type is less likely to loosen if there’s still a lot of bone left at the joint. Expandable stem prosthetics appear to be less likely to loosen, according to the same study.

Increased activity or impact injuries can also increase the risk of the prosthesis loosening.

Radial head replacements can last for many years after an RHA.

A small 2018 study of 32 people who received RHA found that none of them needed any repairs or replacement of the original prosthesis in follow-ups from 7 to 15 years after the surgery.

A much larger 2019 study of 157 people with radial head fractures followed 119 people who received an RHA. About 25% of these people needed the prosthesis repaired or removed about 7 months to a year after RHA.

RHA is often used to treat injuries to the radius that can’t be healed by other means as well as radial head fractures from trauma.

RHA may also be used when osteoarthritis or autoimmune conditions like rheumatoid arthritis have worn down the elbow joint.

This procedure is also sometimes done to treat the degradation of joint tissue that happens as a result of conditions such as Ehlers-Danlos syndrome (EDS).

With EDS, your body doesn’t make enough collagen to support the connective tissues in your joints. A lack of collagen can affect the cartilage in your elbow joint and damage the bones. An RHA can reduce pain and instability in this joint.

RHA costs vary based on your insurance coverage, where the procedure is done, and what kind of prosthesis is used.

The average cost of RHA before insurance ranges from $11,000 to $13,000 but may cost between $1,100 and $2,000 after insurance coverage. The procedure is covered by government programs such as Medicare or Medicaid.

RHA can be a successful surgery for injuries to the head of the radius bone or for wear and tear from arthritis.

After an RHA, be sure to take care of your arm and follow any physical therapy plans closely for the best results.