Radial Head Replacement

Overview

Radial head replacement surgery is a procedure to restore elbow stability and mobility, particularly for patients with severe fractures or joint degeneration. This surgery involves replacing the damaged head of the radius bone with a prosthetic, relieving pain and improving the range of motion to support everyday activities.

Anatomy of the Elbow

posterior, anterior and lateral view of the elbow bones and joint

Fig 1. Elbow Anatomy

The elbow is a hinge joint composed of the humerus (upper arm), radius, and ulna (both forearm bones). The radial head, located at the top of the radius, allows for forearm rotation. Stabilised by ligaments, cartilage, and tendons, the elbow is susceptible to injury, particularly to the radial head, from falls or direct impact, leading to restricted motion and discomfort.

What is Radial Head Replacement Surgery?

x ray of elbow joint after radial head replacement procedure

Fig 2. Radial Head Replacement

Radial head replacement surgery is an open surgery which involves removing a damaged radial head and replacing it with a prosthetic that mimics the natural bone’s movement and structure. Mr. Chua often uses a prosthetic with a pyrocarbon bearing surface, as it closely resembles the mechanical properties of natural bone and cartilage, theoretically improving durability and comfort.

Different Methods & Prosthetics

Radial head replacement may involve various prosthetic types and methods:

  • Fixed Prosthetic Implants: These implants are anchored directly to the bone, providing a stable and fixed structure.
  • Mobile-Bearing Implants: Designed to allow some rotational movement, these implants may be beneficial in cases where forearm rotation is essential.

The choice of implant type and material, such as pyrocarbon or metal, depends on factors like the injury’s complexity and the patient’s lifestyle.

Conditions That May Require a Radial Head Replacement

Several conditions may indicate the need for radial head replacement, including:

  • Severe Radial Head Fractures: Fractures that cannot heal properly with standard treatments like screws or plates.
  • Degenerative Arthritis: Arthritis that erodes the radial head and impairs mobility.
  • Elbow Instability: Caused by prior injuries, leading to recurring pain and a weakened joint.

Patients often experience significant relief from pain and increased range of motion after surgery.

Benefits and Risks

Benefits

Radial head replacement surgery provides several key benefits for patients with severe elbow damage. By replacing the damaged radial head with a prosthetic, the surgery can alleviate persistent pain that restricts daily movement.

Restoring a stable joint structure is also critical, allowing patients to regain elbow strength and a full range of motion, which may have been compromised by previous injury or degeneration.

Following recovery, many patients experience a renewed ability to engage in routine activities, significantly improving their quality of life.

Risks

Potential risks, as with any surgical procedure, include:

  • Infection at the surgical site
  • Nerve Damage, which can cause numbness or weakness
  • Implant Loosening or Wear over time, potentially requiring revision surgery

What Should I Expect?

Before the Procedure

Mr. Chua will conduct a thorough assessment and may recommend imaging tests, such as X-rays or MRIs, to evaluate the injury. He’ll also review your medical history to ensure that surgery is the optimal approach.

During the Procedure

Usually performed under general anaesthesia, the surgery takes 1-2 hours. The damaged radial head is removed, and a prosthetic (preferably pyrocarbon for its bone-like properties) is securely inserted. The elbow may be immobilised temporarily to support healing.

After the Procedure

Following surgery, a physiotherapy plan is essential to restore strength and flexibility. Full recovery takes several months, during which patients will gradually resume activities, aiming for optimal function and pain-free motion within six months.

Frequently Asked Questions

1. How long does it take to recover from radial head replacement surgery?

Recovery times vary, but patients generally see improvement within six months, with continued progress up to a year.

2. Will the implant feel different from my natural bone?

Most patients adapt well to the implant over time. Pyrocarbon implants, in particular, are designed to mimic natural bone’s texture and movement, helping to provide a more comfortable, natural feel.

3. Will I regain full elbow movement after surgery?

Many patients regain significant mobility with physiotherapy, though outcomes depend on the injury’s severity and dedication to rehabilitation.

  1. What is the difference between radial head replacement surgery and elbow replacement surgery?

Radial head replacement is a type of elbow surgery, but it differs from a full elbow replacement. In radial head replacement, only the damaged radial head of the radius (the smaller bone in the forearm) is replaced with a prosthetic, preserving other parts of the elbow joint. In contrast, a total elbow replacement involves replacing both the humerus and ulna surfaces. Radial head replacement is specifically suited for fractures or conditions affecting the radial head alone, rather than the entire elbow joint.

 

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