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Pagpapalit ng Radial Head

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Isang protektadong plano ng paggaling matapos ang pagpapalit ng radial head sa siko gamit ang metal na implant, na nakaayos sa maagang protektadong paggalaw ng siko at bisig upang maiwasan ang paninigas, na ang bisig ay nakaposisyon upang protektahan ang anumang naayos na litid, at ang siko ay ipinapahinga sa simpleng sling para sa ginhawa.

Ilustrasyon ng pagkahulog na nakalatag ang kamay, ang karaniwang paraan kung paano nababali ang radial head.
Ang radial head sa siko ay kadalasang nababasag sa pagkahulog na nakalatag ang kamay; kapag hindi ito maaayos, pinapalitan ito ng metal na implant upang panatilihing matatag at gumagalaw ang siko. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ginagabayan ng protokol na ito ang iyong paggaling matapos ang pagpapalit ng radial head sa siko (kung saan ang isang nabasag na radial head ay pinapalitan ng maliit na metal na implant) kasama si Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong programa ng ehersisyo sa bahay, na sinusundan ng nakabalangkas na klinikal na protokol na isinulat para sa iyong hand therapist; dalhin ang pahinang ito o ang PDF nito sa iyong unang pagbisita sa therapy upang manatiling magkaugnay ang iyong rehabilitasyon. Maaaring iakma ng iyong therapist ang plano depende sa kung paano umuusad ang iyong paggaling at sa kung ano ang eksaktong naayos noong iyong operasyon.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat matapos ang operasyon, makipag-ugnayan sa rooms. Kadalasan ay nakatutulong na kumuha ng litrato ng sugat at i-email ito para sa pagsusuri.

Ano ang aasahan

Ang radial head ay ang bilog na tuktok ng isa sa dalawang buto ng bisig, kung saan ito nakadikit sa siko. Kapag ito ay nabasag sa napakaraming piraso upang maayos, pinapalitan ito ng maliit na metal na implant na nagpapanumbalik ng matatag, kongruwenteng siko at isang makinis na axis ng pag-ikot ng bisig. Kadalasan itong ginagawa bilang bahagi ng pag-aayos ng mas kumplikadong pinsala, isang fracture-dislocation na tinatawag minsan na "terrible triad", kung saan ang radial head, isang piraso ng coronoid, at ang mga litid sa gilid ng siko ay lahat sabay-sabay na napinsala.

Dahil ibinabalik ng implant ang katatagan, ang priyoridad ng iyong rehabilitasyon ay maagang protektadong paggalaw upang maiwasan ang paninigas; ang mga siko ay napakadaling sumigas matapos ang ganitong uri ng pinsala, at ang pinakamahusay na proteksyon laban dito ay ang pagsisimulang gumalaw nang maaga. Ang iyong siko ay ipinapahinga sa simpleng sling para sa ginhawa sa pagitan ng mga ehersisyo (hindi hinged brace), at inaalis ang sling para sa iyong mga ehersisyo at para sa paghuhugas.

Dalawang bagay ang humuhubog sa kung gaano kaaga at gaano kalayo ka gumagalaw:

  • Ang anumang litid na naayos ay kailangang protektahan. Kung ang litid sa labas ng siko (ang lateral collateral ligament) ay naayos, ang bisig ay hinahawakan at inieehersisyo nang nakaikot palad-pababa (pronated) sa simula; kung ang litid sa loob (ang medial collateral ligament) ay naayos, ito ay hinahawakang palad-pataas (supinated); kung pareho, sa neutral na gitnang posisyon. Sasabihin sa iyo ng iyong therapist kung alin ang naaangkop sa iyo.
  • Ang siko ay dapat protektahan mula sa pagilid (varus) na diin at, sa simula, mula sa lubos na pagtuwid kung ang siko ay hindi matatag. Ito ang dahilan kung bakit binubuksan ang paggalaw nang unti-unti sa halip na lahat nang sabay-sabay.

Ang paggalaw ay unti-unting isinusulong, na ang pagpapalakas ay kadalasang nagsisimula mula sa mga anim na linggo at isang pagbabalik sa buong aktibidad sa paligid ng tatlong buwan. Ang implant at ang paggaling ay patuloy na tumatatag nang ilang buwan, kaya naman ang mas mabigat na pagkarga ay unti-unting ibinabalik.

Mga pag-iingat at limitasyon

  • Isuot ang simpleng sling para sa ginhawa ayon sa itinuro; hindi ito hinged brace, at inaalis para sa mga ehersisyo at paghuhugas.
  • Panatilihin ang bisig sa posisyon na ibinigay ng iyong therapist sa mga maagang ehersisyo (palad-pababa kung naayos ang litid sa labas, palad-pataas kung ang nasa loob, neutral kung pareho), na nagpoprotekta sa naayos.
  • HUWAG maglagay ng pagilid (varus) na diin sa siko; iwasan ang pagsandal sa siko o paghahayaang nakabitin nang walang suporta ang braso sa iyong katawan sa simula.
  • HUWAG puwersahin ang lubos na pagtuwid nang maaga kung sinabihan kang hindi matatag ang siko; ituwid lamang sa loob ng iyong pinapayagang saklaw.
  • HUWAG magbuhat, magtulak, humila o magpasan ng bigat sa naoperahang braso hangga't hindi pinapahintulutan (kadalasan sa paligid ng anim na linggo); panatilihing magaan ang maagang paggamit ng kamay.
  • Panatilihing gumagalaw ang iyong balikat, pulso at daliri mula sa simula, at HUWAG magmaneho habang ang iyong braso ay nasa sling o hindi ligtas na makokontrol ang manibela.

Para sa pamamahala ng sugat, pamamaga at peklat, tingnan ang gabay sa pag-aalaga ng sugat ng praktis.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ang mga ito ayon sa gabay ni Dr Hirpara at ng iyong hand therapist, na nananatili sa loob ng anumang saklaw at posisyon ng bisig na ibinigay sa iyo. Pinapanatili ng mga maagang ehersisyo na gumagalaw ang siko at bisig upang maiwasan ang paninigas nang hindi napipilit ang anumang naayos: aktibong-tinutulungang pagbaluktot at pagtuwid ng siko, marahang pag-ikot ng bisig sa iyong pinapayagang direksyon, at pagpapanatiling malaya ang balikat at kamay. Ang pagpapalakas at pag-aalaga ng peklat ay kabilang sa mas huling mga yugto at hindi dapat simulan hangga't hindi ka tiyak na pinahintulutan. Itigil ang anumang nagdudulot ng matalim na sakit o pakiramdam na ang siko ay bumibigay.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang nakahakbang na klinikal na protokol para sa rehabilitasyon matapos ang pagpapalit ng radial head (radial head arthroplasty), na kadalasang ginagawa para sa isang hindi maaaring itayong muli na comminuted radial head fracture, kadalasan bilang bahagi ng isang terrible-triad fracture-dislocation. Ang seksyong ito ay ibibigay sa hand therapist, at bawat yugto ay nagbubukas ng isang malinaw na paliwanag sa payak na Ingles kung ano ang nangyayari. Ibinabalik ng implant ang isang matatag, kongruwenteng radiocapitellar articulation, kaya ang gabay na prinsipyo ay maagang protektadong paggalaw upang maiwasan ang paninigas na madaling mangyari sa mga sikong ito, na ang arc at pag-ikot ng bisig ay kinokontrol ng integridad ng anumang collateral-ligament at coronoid na naayos.

Bago ang paggamot, tingnan ang operation report ng pasyente at ang examination-under-anaesthesia na pagtatasa ng katatagan, at makipag-ugnayan sa treating surgeon hinggil sa: kung aling collateral ligaments at/o coronoid ang naayos, ang matatag na arc na ipinakita habang nag-ooperasyon, at ang protektibong pag-ikot ng bisig. Ipinapahinga ni Dr Hirpara ang siko sa simpleng sling para sa ginhawa (walang hinged brace) at pinapaboran ang isang pinabilis, maagang-paggalaw na paraan kung saan pinapahintulutan ng katatagan. Panuntunan sa posisyon ng bisig: LCL repair → mag-ehersisyo/magpahinga sa pronation; MCL repair → supination; pareho → neutral na gitnang posisyon; iwasan ang varus na diin at, kung saan hindi matatag ang siko, ang terminal extension nang maaga.

Phase I — maagang protektadong paggalaw (linggo 0 hanggang 2)

Ang unang dalawang linggo ay nagsisimula ng marahang protektadong paggalaw sa sandaling pahintulutan ng katatagan ng sugat (kadalasan sa loob ng unang linggo) upang maunahan ang paninigas. Ang braso ay nagpapahinga sa simpleng sling para sa ginhawa, na inaalis para sa mga ehersisyo at kalinisan. Ang siko ay gumagalaw sa loob ng ligtas nitong arc habang ang bisig ay hinahawakan sa protektibong pag-ikot para sa alinmang litid ang naayos.

Para sa iyong hand therapist:

Edukasyon at mga pag-iingat - I-immobilise sa simpleng sling para sa ginhawa (walang hinged brace); inaalis para sa mga ehersisyo at paghuhugas - Simulan ang aktibong-tinutulungan/aktibong flexion–extension ng siko sa loob ng intra-operatibong ipinakitang matatag na arc; iwasan ang terminal extension kung hindi matatag ang siko - Pag-ikot ng bisig sa protektibong posisyon: pronation kung naayos ang LCL, supination kung naayos ang MCL, neutral na gitna kung pareho - Walang varus na diin anumang oras; magsagawa ng mga overhead na ehersisyo nang nakahiga kung saan hindi matatag upang maneutralisa ang varus at gamitin ang gravity upang idikit ang joint - Walang pagpasan ng bigat o pagtutulak sa naoperahang braso

Pamamahala - Sugat: surgical dressings ayon sa itinuro; kumpirmahin ang katatagan ng sugat bago simulan ang paggalaw - Oedema: elevation, marahang hand pump, yelo kung kinakailangan - Ehersisyo: AAROM/aktibong flexion–extension ng siko sa loob ng matatag na arc; pro/sup ng bisig sa protektadong direksyon habang nasa 90° ang siko; buong aktibong ROM ng balikat, pulso, kamay at hawak

Pamantayan upang umusad - Gumagaling na ang sugat; komportable, kontroladong paggalaw sa loob ng protektadong arc

Phase II — pagsulong ng arc at pag-ikot ng bisig (linggo 2 hanggang 6)

Mula sa mga dalawa hanggang anim na linggo, ang protektadong arc ay unti-unting pinapalawak patungo sa lubos na pagtuwid at ang pag-ikot ng bisig ay binubuksan sa parehong direksyon, na may layuning makamit ang buong pronation/supination sa mga walong linggo. Ang pagpapalakas at pagkarga ay pinipigil pa rin.

Para sa iyong hand therapist:

Mga pagtatasa - Aktibo at pasibong flexion–extension ng siko at pag-ikot ng bisig; sakit at pamamaga; pagsusuri ng sugat/peklat; mga sintomas ng katatagan

Edukasyon at mga pag-iingat - Umusad patungo sa lubos na pagtuwid kung saan pinapahintulutan ng katatagan (unti-unting alisin ang anumang maagang extension block) - Umusad ang pag-ikot ng bisig sa parehong direksyon patungo sa buo, habang maingat pa rin sa naayos na litid sa unang bahagi ng yugtong ito - Patuloy na iwasan ang varus na diin at anumang pagkarga sa braso

Pamamahala - Ehersisyo: palawakin ang flexion–extension arc ng siko patungo sa buo; isulong ang pro/sup patungo sa buong ROM (target na buo sa ~8 na linggo); simulan ang pamamahala ng peklat kapag gumaling na ang sugat; ipagpatuloy ang ROM ng balikat/pulso/kamay - Isang overhead (nakahiga) na programa ng paggalaw ay nananatiling kapaki-pakinabang kung saan ang natitirang instability ay isang alalahanin

Pamantayan upang umusad - Papalapit sa buong walang-sakit na ROM; walang mga sintomas ng instability; sakit ≤3/10

Phase III — pagpapalakas at pagbabalik (linggo 6 hanggang 12 at higit pa)

Kapag naibalik na ang paggalaw at itinuring nang matatag ang mga naayos (kadalasan sa mga anim na linggo), nagsisimula ang pagpapalakas at unti-unting itinataas (hawak muna, pagkatapos may-resistensyang gawain sa siko at bisig), na umuusad sa mga sumusunod na linggo. Ang pagbabalik sa mas mabigat na aktibidad ay batay sa pamantayan, kadalasan sa paligid ng tatlong buwan.

Para sa iyong hand therapist:

Mga pagtatasa - Lakas ng siko at bisig kumpara sa kabilang panig; tugon ng sakit/pamamaga sa pagkarga; functional at work-/sport-specific na pagsubok kung naaangkop

Edukasyon at mga pag-iingat - Simulan ang marahang may-resistensyang pagpapalakas (hawak → may-resistensyang flexion–extension at pro/sup ng siko) mula sa mga anim na linggo; unti-unting dagdagan ang pagkarga - Umusad patungo sa functional at work-specific na pagkarga ayon sa kaya; iwasan ang biglaang mabigat o impact na pagkarga nang maaga

Pamamahala - Ehersisyo: progresibong may-resistensyang pagpapalakas ng siko/bisig (band → magaang timbang); pagpapalakas ng hawak; gradadong functional na pagkarga; ipagpatuloy ang anumang natitirang gawain sa paggalaw - Bantayan at iulat ang paulit-ulit o lumalalang sakit, mekanikal na sintomas o pagkawala ng paggalaw (posibleng implant overstuffing/loosening o capitellar wear), at i-refer pabalik sa treating doctor kung ang paggaling ay huminto o may mahinang resulta - Isaalang-alang ang discharge kapag ang paggalaw ay functional na at ang lakas ay halos simetriko

Pamantayan para sa pagbabalik sa buong aktibidad - Functional na walang-sakit na ROM; halos simetrikong lakas; may-kompiyansa, matatag na siko sa ilalim ng pagkarga

Pagbabalik sa trabaho at aktibidad

Ang magaang pang-araw-araw na paggamit ng kamay (pagkain, pagsulat, magaang pag-aalaga sa sarili) ay hinihikayat mula sa simula, sa loob ng ginhawa, hangga't hindi ito nagsasangkot ng pagtutulak, pagbubuhat o pagpasan ng bigat sa siko. Dahil hindi ka dapat magmaneho habang ang braso ay nasa sling o hindi ligtas na makokontrol ang manibela, magplano ng tulong sa transportasyon sa mga unang linggo; nagpapatuloy ang pagmamaneho kapag wala ka na sa sling at makokontrol mo na ang sasakyan, ayon sa nakumpirma sa iyong pagsusuri.

Ang pagpapalakas ay kadalasang nagsisimula mula sa mga anim na linggo at unti-unting itinataas. Ang pagbabalik sa mas mabigat na trabaho, pagbubuhat at isport ay kadalasang sa paligid ng tatlong buwan, at nakabatay sa muling pagkakamit ng buong walang-sakit na paggalaw at sapat, simetrikong lakas na may matatag na siko, na hinuhusgahan ni Dr Hirpara at ng iyong hand therapist sa halip na kalendaryo lamang. Ang mas mabigat na manwal na trabaho at contact sport ay sumusunod sa parehong pantatas-na-pamantayang pagsulong.

Matapos ang iyong protokol

Ang protokol na ito ay gumagana kasabay ng pangkalahatang payo sa paggaling ng praktis; tingnan ang pamamahala ng sakit matapos ang operasyon, pag-aalaga ng sugat at pamamahala ng peklat. Ang nakahakbang na plano sa itaas ay sumasalamin sa nailathalang gabay sa rehabilitasyon matapos ang radial head arthroplasty at terrible-triad na muling pagtatayo, at ang iyong patuloy na paggaling ay ginagabayan nang paisa-isa ni Dr Hirpara at ng iyong hand therapist ayon sa kung paano umuusad ang iyong siko at kung ano ang eksaktong naayos.

Reviewed by Dr Kieran Hirpara · 21 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Radial Head Replacement — Procedure Outcomes & Post-operative Rehabilitation (Radial Head Arthroplasty for Unreconstructable Fracture / Terrible Triad)

Topic scope: post-operative rehabilitation after radial head arthroplasty (RHA) — replacement of an unreconstructable comminuted radial head with a metallic implant — performed either in isolation or, more commonly, as one component of reconstructing a fracture-dislocation (the "terrible triad": radial head + coronoid + lateral collateral ligament ± medial collateral ligament). The radial head is a key secondary stabiliser of the elbow against valgus and axial (posterolateral rotatory) load, so the implant exists to restore a stable, congruent radiocapitellar articulation and forearm axis — not merely to fill a defect.

Defining principle of the rehab here: the implant restores stability, so the dominant clinical enemy is stiffness, to which these elbows are strongly predisposed. The rehab is therefore an early protected-motion pathway — start moving within days to a week — explicitly gated by the integrity of the collateral-ligament and coronoid repairs done at the same operation. The two deliberate restraints are (1) the forearm rotation position that offloads the repaired ligament (pronation protects a repaired LCL; supination protects a repaired MCL; neutral mid-range when both), and (2) avoidance of varus stress and, where the elbow was unstable, early terminal extension. A simple sling is worn for comfort — not a hinged brace. The single biggest branch point is how much residual instability was demonstrated on examination under anaesthesia, which determines how fast the arc and forearm rotation are released.

A. PROCEDURE OUTCOMES (radial head arthroplasty; repair-vs-replace context)

Metallic RHA is a reliable reconstruction for the unreconstructable radial head, and — critically for rehab — it restores enough stability to permit early motion even in the setting of associated dislocation, provided the ligaments and coronoid are addressed.

  • RHA restores elbow stability and kinematics when the native head is unreconstructable, but ligament repair is required to fully restore stability. Cadaveric work shows radial head excision alters kinematics and stability, arthroplasty restores them in the ligament-intact elbow, and in the ligament-disrupted elbow arthroplasty plus LCL repair is needed to correct varus–valgus laxity [Beingessner et al., J Bone Joint Surg Am 2004, DOI 10.2106/00004623-200408000-00018]. Strong (mechanistic/biomechanical).
  • RHA gives functional, durable ROM in unstable elbow injuries equivalent to stable injuries. A 15-year single-surgeon series (68 patients) found patients with unstable radial head fractures plus dislocation achieved flexion and rotational arcs similar to stable injuries, with no difference in complication rate or implant survivorship — though supination loss was ~10° greater in the unstable group [Lott et al., J Shoulder Elbow Surg 2018, DOI 10.1016/j.jse.2017.10.011]. Moderate (Level II cohort).
  • Long-term monopolar implant survival is good, with stiffness/sizing the main failure modes. A 15-year follow-up of the Acumed anatomical (press-fit, monopolar) implant for Mason III–IV fractures confirms durable function and survival, with the principal complications being joint stiffness, malpositioning and improper sizing [Tarallo et al., J Shoulder Elbow Surg 2026, DOI 10.1016/j.jse.2025.05.038]. Moderate (long-term cohort).
  • Implant failure/revision risk is real, especially with associated instability. In a young active (military) cohort, RHA carried higher implant-failure rates than ORIF (20% vs 2.9%), and dislocation, coronoid fracture and concomitant ligament repair each predicted complications — underscoring that the injury complex, not just the implant, drives outcome [Kusnezov et al., HAND 2017, DOI 10.1177/1558944717715136]. Moderate.
  • Terrible-triad reconstruction aims explicitly to restore stability sufficient for early motion. Comprehensive reviews frame the entire surgical sequence (LCL repair, radial head fix/replace, ± coronoid, ± MCL/fixator) as a means to permit early ROM and pre-empt stiffness, posttraumatic arthrosis and instability [Fahs et al., J Am Acad Orthop Surg 2024, DOI 10.5435/jaaos-d-24-00310]. Moderate–strong (narrative review).

B. REHABILITATION / THERAPY EVIDENCE

The rehab evidence base is built on biomechanics + surgical-series protocols rather than RCTs: there is strong agreement on early protected motion and on forearm-position-based ligament protection, but the exact arc and timing are individualised to intra-operative stability.

  • Early motion is the consensus priority to prevent stiffness. Across operative series and textbook protocols, formal active and active-assisted ROM is begun within the first week once wound stability is confirmed, with splinting between sessions usually discontinued by 2–3 weeks and strengthening from ~6 weeks [Monica & Mudgal, Hand Clin 2010, DOI 10.1016/j.hcl.2010.04.008; Duckworth et al., Clin Orthop Relat Res 2014, DOI 10.1007/s11999-014-3516-y]. Moderate (consensus/series).
  • Motion is gated by stability, with varus stress avoided at all times. Where instability is a concern, an overhead (supine) rehabilitation protocol begun ~10–14 days post-op achieves early motion while gravity coapts the joint and neutralises varus; "a stiff stable elbow is preferred over a loose incongruous one" [Rockwood and Green's Fractures in Adults, 2019]. Moderate (textbook consensus).
  • Forearm rotation is positioned to protect the repaired ligament. Published RHA protocols position and exercise the forearm in pronation when the LCL was repaired, supination when the MCL was repaired, and neutral mid-range when both were repaired, progressing to full rotation as the repair consolidates [single-centre RHA protocol & narrative review, ResearchGate 2018; UVA / Christ Hospital RHA PT protocols — see URLs]. Weak–moderate (protocol consensus).
  • A coronoid fracture treated without fixation does not preclude early motion in selected triads. Where the LCL and radial head are addressed and intra-operative fluoroscopic stability is confirmed, type I–II coronoid fractures can be left unfixed and still rehabilitated with early motion to good ROM and DASH scores [Papatheodorou et al., Clin Orthop Relat Res 2014, DOI 10.1007/s11999-014-3471-7]. Moderate (Level IV series).
  • Restoring radiocapitellar contact (by replacement) is what permits the early-motion pathway in the unstable elbow; conservative or excision pathways are reserved for stable patterns and depend on the same early-mobilisation principle [Charalambous et al., J Shoulder Elbow Surg 2011, DOI 10.1016/j.jse.2011.02.013]. Moderate.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Therapy focus Strength / load Notes
I — Early protected motion Week 0–2 (often start <1 wk) Simple sling for comfort (no hinged brace); stable-arc only; forearm in ligament-protective rotation; no varus stress Active/active-assisted elbow flexion–extension within the intra-operative stable arc; forearm pro/sup in the protected direction; full shoulder/wrist/hand ROM; supine overhead programme if unstable None Wound stability confirmed before motion; "stiff-stable > loose-incongruous"
II — Arc & rotation progression Week 2–6 Release extension block / forearm rotation gradually as stability allows Progress elbow arc to full extension; open forearm rotation both directions; scar management once healed None Aim full pronation/supination by ~8 weeks; supination is the slowest to recover (~10° residual loss common)
III — Strengthening & return Week 6–12+ Restrictions lifted as repairs consolidate Grip → resisted elbow/forearm strengthening; graded functional and work-specific loading Begin ~6 wk, build gradually Return to heavier work/sport criterion-based ~3 months; watch for overstuffing/loosening/capitellar wear

(Phase windows mirror the precautions in the patient protocol; they are typical, stability-gated guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Repair (ORIF) vs replace (RHA) the radial head. For reconstructable heads, ORIF is generally preferred and no prosthesis equals the native head biomechanically; for unreconstructable comminution (Mason III–IV) or in the unstable/dislocated elbow, RHA is the more reliable option because fixation constructs fail under the higher stresses [Kusnezov et al. 2017; Charalambous et al. 2011; Leigh & Ball, J Shoulder Elbow Surg 2012, DOI 10.1016/j.jse.2012.03.005]. Moderate; selection-dependent.
  2. Terrible-triad early motion vs protected immobilisation. Modern practice favours restoring enough stability (LCL ± radial head ± coronoid ± MCL/fixator) to permit early motion and avoid stiffness; the supine/overhead protocol exists precisely to reconcile early motion with residual instability. The trade-off ("stiff-stable preferred over loose-incongruous") is consensus, not RCT-settled [Rockwood and Green 2019; Fahs et al. 2024]. Moderate (consensus).
  3. Monopolar vs bipolar implants. Both are used; bipolar designs were intended to self-align and tolerate sizing imperfection, while monopolar anatomical implants show good long-term survival. No clear superiority is established, and overstuffing/sizing error harms either design more than the bearing type does [Tarallo et al. 2026; Doornberg et al., J Bone Joint Surg 2007, DOI 10.2106/jbjs.e.01340]. Weak (no head-to-head superiority).
  4. Implant-related complications. Overstuffing the radiocapitellar joint, malsizing and stem loosening cause capitellar erosion/osteopenia, pain and stiffness; capitellar erosion is reported from metal-on-cartilage articulation, and accurate head height/diameter is the key technical guard [Van Riet et al., J Bone Joint Surg 2004, DOI 10.2106/00004623-200405000-00028; Monica & Mudgal 2010]. Rehab cannot fix a malsized implant — persistent loading pain/stiffness warrants surgical review. Moderate.
  5. Supination is the laggard. Across series, forearm supination is the motion most likely to remain mildly deficient (≈10° loss), partly from scarring and partly from MCL-protective early positioning; patients should be counselled accordingly [Lott et al. 2018]. Moderate natural-history.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (biomechanical / mechanistic): RHA restores elbow stability and kinematics only in concert with collateral-ligament repair (varus–valgus laxity corrected by RHA + LCL repair, not RHA alone).
  • MODERATE: functional ROM after RHA in unstable injuries equivalent to stable injuries with good implant survivorship (Level II–IV cohorts); long-term monopolar implant survival with stiffness/sizing as main failure modes; early-motion-to-prevent-stiffness as the governing rehab principle; supine/overhead protocol for the unstable elbow; supination as the slowest-recovering arc.
  • WEAK / CONSENSUS: the specific forearm-position-by-repaired-ligament rehab rule (pronation for LCL, supination for MCL, neutral for both) and the exact phase timings (protocol-derived, stability-gated, not RCT-validated); monopolar-vs-bipolar bearing choice (no proven superiority).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • The Effect of Radial Head Excision and Arthroplasty on Elbow Kinematics and Stability. J Bone Joint Surg Am. 2004. DOI: 10.2106/00004623-200408000-00018
  • Radial Head Arthroplasty. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.04.008
  • Results after radial head arthroplasty in unstable fractures. J Shoulder Elbow Surg. 2018. DOI: 10.1016/j.jse.2017.10.011
  • Long-term survival of Acumed anatomical radial head implant for Mason type III-IV fractures: a 15-year follow-up. J Shoulder Elbow Surg. 2026. DOI: 10.1016/j.jse.2025.05.038
  • Operative Management of Unstable Radial Head Fractures in a Young Active Population. HAND. 2017. DOI: 10.1177/1558944717715136
  • Management of Elbow Terrible Triad Injuries: A Comprehensive Review and Update. J Am Acad Orthop Surg. 2024. DOI: 10.5435/jaaos-d-24-00310
  • Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? Clin Orthop Relat Res. 2014. DOI: 10.1007/s11999-014-3471-7
  • Radial Head Replacement for Acute Complex Fractures: What Are the Rate and Risk Factors for Revision or Removal? Clin Orthop Relat Res. 2014. DOI: 10.1007/s11999-014-3516-y
  • Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg. 2012. DOI: 10.1016/j.jse.2012.03.005
  • Comminuted radial head fractures: aspects of current management. J Shoulder Elbow Surg. 2011. DOI: 10.1016/j.jse.2011.02.013
  • Radial Head Arthroplasty with a Modular Metal Spacer to Treat Acute Traumatic Elbow Instability. J Bone Joint Surg Am. 2007. DOI: 10.2106/jbjs.e.01340
  • Capitellar Erosion Caused by a Metal Radial Head Prosthesis. J Bone Joint Surg Am. 2004. DOI: 10.2106/00004623-200405000-00028
  • Comparative study of radial head resection and prosthetic replacement in surgical release of stiff elbows. Int Orthop. 2014. DOI: 10.1007/s00264-014-2594-5
  • Rockwood and Green's Fractures in Adults (terrible-triad surgical pitfalls; overhead/early-motion protocol; "stiff-stable preferred"). Wolters Kluwer, 2019.

Radial head replacement rehabilitation literature (URLs)

  • Rehabilitation protocol after radial head arthroplasty — a single-centre experience and narrative review of the literature. ResearchGate (2018). https://www.researchgate.net/publication/326168570
  • University of Virginia, Department of Orthopaedic Surgery — Radial Head Replacement Rehabilitation Guidelines (forearm-position-by-ligament; arc progression). https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Radial-head-replacement.pdf
  • The Christ Hospital — Radial Head Replacement Physical Therapy Protocol (Rao). https://www.thechristhospital.com/landingpages/Documents/Rao%20PT%20Protocols/Operative/Elbow/Rao%20Radial%20Head%20Replacement%20r1.pdf
  • Cheshire Arm Clinic — Physiotherapy Protocol for Radial Head Replacement. https://cheshirearmclinic.co.uk/wp-content/uploads/2021/09/Radial-Head-Replacement.pdf
  • Denver Shoulder — Rehabilitation Protocol: Radial Head Replacement. https://www.denvershouldersurgeon.com/pdf/radial-head-replacement-protocol.pdf

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