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Radial head arthroplasty

120 citationsUpdated Sep 2026

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Overview

Radial head arthroplasty serves as a reliable surgical option for comminuted radial head fractures and complex elbow trauma that are not amenable to reconstruction [1]. This procedure is particularly indicated when fractures are associated with unstable elbows or forearm injuries, provided that concomitant injuries are addressed [10]. While radial head resection remains preferable for stable elbows due to lower cost and demand, replacement is recommended for unstable joints [44]. Clinical outcome studies indicate that head replacement yields better outcomes than excision regarding elbow stability, range of motion, pain, and complication rates [46]. Specifically, radial head replacement appears to reach better outcomes in patients with Mason type III fractures followed for five years or less [11]. Adequate knowledge of surgical indications, implant types, and technique is essential for satisfactory results in nonreconstructable fractures [27].

Metallic radial head arthroplasty yields satisfactory results in acute unreconstructable fractures or as a salvage procedure for previously treated injuries [7]. Pyrocarbon prostheses are an acceptable option for unreconstructable fractures, yielding good functional and radiological outcomes [15]. Modular systems have shown promising short- to midterm findings [17], and the overall midterm outcome of press-fit bipolar arthroplasties can be considered favorable [148]. Long-term outcomes are satisfactory, though a high complication and revision rate results in implant survival of 75.1% at 18 years, with the highest annual failure rate observed in the first postoperative year [54]. Despite a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups [26].

Younger patients should be counseled regarding the increased risk of requiring further surgery [6]. A secondary radial head prosthesis and a worse clinical outcome (MEPS < 85 points) significantly increase the risk of not returning to sports [23]. Overlengthening is a complication requiring identification and treatment [9]. Significant radiographic differences exist between frequently used implants, specifically regarding radial neck dilatory remodeling after use of an uncemented, press fit, fully chemically etched stem design [4]. Partial radial head arthroplasty may be a viable option for restoring joint congruity in young patients with partial radial head deficiency [8]. Longer-term studies are required to ascertain whether apparent benefits are offset by late complications such as loosening [5]. Reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus definition of failure reasons [3].

Anatomy & Pathophysiology

Bony Anatomy

The radial head is disk-shaped with a slightly elliptical cross section and a greater diameter than the neck [97, 115]. It possesses a shallow cuplike surface that articulates proximally with the capitellum and medially with the radial notch of the ulna [97]. The entire radial head is covered with articular cartilage, and its non-cylindrical shape permits the proximal-distal pistoning effect of the radius during forearm rotation while guiding the supination-pronation arc [97, 125]. The head interdigitates precisely with the lesser sigmoid notch, the lateral lip of the trochlea, and the capitellar articular surface [115]. The proximal radius exhibits a slight angulation relative to the shaft and is offset relative to the radial neck [80, 115].

The nonarticular surface of the radial head is relatively small, defined as an arc of roughly 90 degrees with its midpoint directly lateral when the arm is in a neutral position [115]. This nonarticular area has a slightly greater margin anteriorly [115]. The area between the Lister tubercle and the radial styloid on the distal radius serves as a rough guide to this nonarticular safe zone [115]. The biceps inserts on the tuberosity of the radial head immediately distal to the neck [97].

In pediatric patients, the secondary ossification center of the proximal radius appears as a small sphere between the third and fifth years of life and fuses with the shaft between ages 16 and 18 [97]. The blood supply to the radial head epiphysis is limited and tenuous, entering through the more distal metaphysis [97, 115]. Significant differences exist between 3D and 2D lateral measurements of the radial neck axis angulation [155].

Implant Sizing and Alignment

The native radial head is somewhat elliptical, and the optimal diameter of a radial head implant is typically the minor diameter of this elliptical shape [80]. This optimal diameter is most commonly 2 mm smaller than the maximum diameter of the native radial head [80]. The radial head should articulate at the level of the proximal radial ulnar joint, which is typically 2 mm distal to the tip of the coronoid [80]. The bicipital tuberosity and distal radius are unreliable landmarks for radial head implant alignment, as measured landmarks show no consistent rotational relationship with the maximum diameter of the radial head [153].

Ligaments and Stability

The radial head serves as a secondary valgus stabilizer of the elbow, contributing considerably to the neutralization of valgus forces across the axially loaded, fully extended elbow [35, 60, 125]. The primary stabilizers of the elbow are the medial collateral ligament (MCL) and lateral ulnar collateral ligament (LUCL) [125]. An intact radial head or its substitute can unload an injured MCL, allowing the ligament to heal without formal repair in most instances [125]. Additionally, the radial head along with the LUCL prevents posterolateral rotatory instability [125]. The buttressing effect of the radial head prevents proximal migration of the radius when interosseous membrane injury is present [125]. Ligaments have the most marked influence on elbow stability, particularly when the upper limb is positioned such that valgus and varus gravity loads are applied [114].

The posterior interosseous nerve runs deep to the supinator along the lateral aspect of the radial neck [115]. Full pronation provides an average of approximately 5 cm of safe area for dissection and internal fixation near the radial neck [115].

Injury Mechanisms and Pathophysiology

Radial head fractures typically result from a fall on an outstretched hand with the forearm in pronation, resulting in an axial load on the elbow [35, 60, 189]. The mechanism of injury for most radial head fractures involves a fall on the outstretched hand with the elbow partially flexed and pronated [189]. Dislocation of the elbow is another cause of radial head fractures [60].

Specific loading patterns produce distinct injury patterns: * Valgus load: Causes impaction of the radial head into the capitellum, commonly with rupture of the MCL [118]. * Posterolateral rotatory subluxation: Causes a partial articular shear fracture of the anterior portion of the radial head, often with rupture of the LCL [118]. * Axial forearm load: Causes impaction of the radial head into the capitellum; more severe trauma produces a fracture of the coronoid or rupture of the interosseous membrane and distal radioulnar joint ligaments [118].

The Essex-Lopresti injury is defined by longitudinal disruption of the interosseous membrane, distal radioulnar joint injury, and radial head fracture or dislocation, resulting in axial instability of the forearm [60, 118].

In children, the cartilaginous radial head is resistant to fracture, making radial neck fractures more common than head fractures [97]. Approximately 50% of radial neck fractures in children are associated with other injuries to the elbow [97]. These fractures may occur as a result of a fall onto an outstretched hand with the elbow in extension and valgus, or as a result of dislocation of the elbow [97]. The radial neck may be fractured by impact against the inferior aspect of the capitellum at the time of posterior dislocation or spontaneous reduction [97]. A radial head fracture may occur with anterior dislocation of the elbow and produce anterior displacement of the head [97].

Associated Injuries

Radial head and neck fractures are the most common fractures about the elbow, accounting for 15–25% of all elbow fractures [35, 60, 125]. Approximately 20% of all elbow fractures involve the radial head [35]. These fractures account for 3% of all fractures seen in emergency departments, and approximately 75% of all proximal forearm fractures involve the radial head and/or neck [125]. The incidence of radial head fractures is 28 per 100,000 population per year, while the combined incidence of radial head and neck fractures is 55 per 100,000 population per year [125]. Radial head fractures are more common in women than in men, most frequently occurring between the ages of 20 and 60 years [118]. The average age of men with radial head fracture injury is 37 years, compared to 52 years for women [125].

Of patients with radial head fractures, 30% have other soft-tissue and skeletal injuries [35]. Associated injuries include: * Ligamentous: Tears of the LCLs and/or MCLs are most commonly associated with radial head fractures [118]. * Bony: Dislocations of the elbow and fractures of the coronoid, capitellum, olecranon, and proximal ulna are frequent associations [118]. * Distal/Forearm: Carpal fractures, distal radioulnar joint (DRUJ) disruption, interosseous membrane disruption, and Monteggia fracture-dislocations [35].

Rupture of the interosseous membrane is uncommon but best diagnosed and treated early, as late reconstruction is challenging and often unsatisfactory [118]. Undisplaced and minimally displaced radial head fractures typically occur as isolated injuries, whereas more displaced and comminuted fractures commonly have associated injuries to the collateral ligaments or fractures of the coronoid, capitellum, or proximal ulna [118]. In high-energy trauma, dislocations of the elbow and/or forearm can occur with radial head fractures [118]. The majority of radial head and neck fractures are minimally displaced and are isolated injuries [118]. The addition of a coronoid fracture to an elbow dislocation with a radial head fracture substantially increases the chances of acute and chronic instability and posttraumatic elbow arthrosis [113].

Congenital dislocation of the radial head is the most common congenital anomaly of the elbow, with about 60% of cases accompanied by other upper extremity congenital anomalies [68]. It is associated with congenital radioulnar synostosis and syndromes including Klinefelter, Cornelia de Lange, Ehlers-Danlos, and nail-patella syndromes [68]. In these cases, the radial head is generally convex instead of concave, and the capitellum is hypoplastic and ovoid instead of convex [68]. Monteggia fractures account for less than 1% of all pediatric elbow dislocations, and radial nerve injury has been reported to occur in 10% to 20% of patients with Monteggia fractures [69].

Biomechanics and Kinematics

Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics [25]. Changing the length of the radial neck significantly alters elbow kinematics [92]. Lengthening the radial neck by 2.5 mm or more forces the ulna into a more varus and externally rotated position even with the application of valgus stress [92]. Shortening the radial neck by 2.5 mm or more causes the ulna to track in a valgus and internally rotated position and increases total laxity of the elbow [92]. Altered elbow kinematics or maltracking of the ulno-humeral joint due to altered radial neck length could induce degenerative disease due to abnormally high stresses on the cartilage [92].

The kinematics of the elbow joint deviated increasingly from native joint kinematics with a +2 mm to a +4 mm radial overlengthening [91, 93]. A few degrees or mm changes in elbow kinematics could potentially increase stress to the interosseous membrane and contact pressure within the joint [94]. Proper balancing and adequate bone resection from the radial head are mandatory for obtaining normal elbow kinematics during the radial head arthroplasty procedure [101].

The kinematics of the radiocapitellar joint are different after bipolar arthroplasty than in the normal elbow, with abnormal positioning of the prosthetic radial head in supination and evidence of insufficient intraprosthetic motion observed [110]. The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure, although different patterns of contact pressure and area curves during elbow flexion-extension were observed between native radial heads and anatomic radial head prostheses [131]. No statistical differences in radiocapitellar joint contact mechanics as measured by 3-dimensional joint congruency were found among three implant geometries in cadaveric specimens undergoing continuous simulated forearm rotation [129]. The radiocapitellar gap is significantly smaller under load during elbow flexion compared with extension [189].

Implant sizing errors have specific biomechanical consequences: * Oversizing: An implant whose diameter is too large may cause erosion of the lateral trochlea, prevent optimal closure of the annular ligament, and contribute to residual instability [80]. Oversizing may "stabilize" the elbow by placing the entire lateral soft tissue complex on tension but may cause capitellar arthrosis and pain [72]. * Overlengthening: Overlengthening with the placement of a radial head prosthesis that is too thick may be associated with the development of pain, stiffness, and capitellar wear [80]. Overlengthening causes the medial ulnohumeral joint to open laterally, which may not be evident until there is 6- to 8-mm overlengthening of the radial head insert [80]. A nonparallel medial ulnohumeral joint space may suggest overstuffing, and comparing radiographs of the uninjured elbow is the best investigation when overstuffing is suspected [147]. * Maltracking: Radial head implant maltracking causes premature capitellar cartilage wear, pain, limited rotation, and may contribute to loosening of fixed stem prostheses [80].

Radiographic parameters are not very useful to detect overlengthening of the radial head, as the lateral ulnohumeral joint is often wider in normal patients [80]. The reconstructed articular surface should end up no more than 1 mm proud of the visible proximal corner of the lesser sigmoid notch [72].

Excision of the radial head alone has been shown to alter elbow kinematics even in the presence of intact collateral ligaments [43]. Long-term outcome studies have shown a high incidence of radiographic arthritis, an increase in the carrying angle, and proximal radial migration following radial head excision [73]. However, the functional outcome with radial head excision for isolated fractures has been good in the majority of patients [73]. Radial head resection is preferable if the elbow is stable due to being less demanding and cheaper, while replacement is recommended for unstable elbows [44]. Joint stability is achieved and secondary complications like valgus elbow deformity and proximal radial migration are prevented by radial head replacement [122]. Achieving full stability of the elbow and avoiding overstuffing are necessary to prevent acute disassembly of a bipolar radial head arthroplasty [123].

Whether there is a significant clinical advantage of a more anatomically shaped radial head implant requires additional study [52]. A single component would suffice for right and left elbows, but a perfectly conforming prosthesis is practically impossible due to large variations in normal anatomy [144]. The anatomical parameters of the proximal radius of each case and the radial head implant specifications should be assessed when selecting a radial head implant [28]. Clinical outcome studies of metallic radial head arthroplasty systems indicate that head replacement is a reasonable option to offer patients with comminuted radial head fractures and complex elbow trauma [1]. In the setting of an irreconstructable radial head and neck fracture, radial head arthroplasty is an excellent option in restoring radiocapitellar contact and elbow stability [43]. Prosthetic head and stems have a wide variety of height, size, and offset to best replicate native radial heads [43].

The most commonly used radial head replacement prosthesis is a modular, metallic, smooth stem noncemented prosthesis [35]. The ideal method of fixation of radial head prostheses remains elusive [35]. Press-fit prostheses with a rough surface that do not obtain ingrowth or loosen can cause extensive osteolysis [35]. Silicone replacements should not be used for radial head arthroplasty [72]. Short-term results appear similar whether the radial head is replaced or repaired [72]. Radial head resection is a commonly used procedure for symptomatic radiocapitellar dysfunction, with typical indications including isolated radiocapitellar arthritis, mechanical block to pronation-supination in the posttraumatic elbow, and inflammatory arthritis in association with a debridement procedure [149]. Radial head resection has been described for acute comminuted radial head fractures [149].

Classification

Mason: The Mason classification defines Type I as a non-displaced marginal fissure or fracture [179]. Type II is defined as a displaced marginal fracture with separation or impaction [179]. Type III involves a displaced comminuted fracture of the entire radial head [179]. Broberg and Morrey added a Type IV, defined as a radial head fracture combined with elbow dislocation [179]. Mason originally classified "marginal" and "undisplaced" fractures as Type 1, and "displaced" partial fractures larger than a marginal fragment as Type 2 [42]. Broberg and Morrey suggested that a Type 2 fracture requires the fragment to constitute ≥ 30% of the articular surface and be displaced by ≥ 2 mm [42].

Hochkiss: Hochkiss modified the Mason classification by defining Type II as a displaced fracture of the radial head or neck combined with mechanical blocking of joint motion or with loss of joint congruity [179]. Type III is defined as comminution that precludes internal fixation and requires either resection or prosthetic replacement of the radial head [179].

Mayo Clinic: The Mayo Clinic classification considers all concomitant lesions and is preferred over the Mason classification [179]. In this system, the radial head fracture is described using the Mason classification, with letters added to indicate concomitant lesions [179]. Upper case letters indicate treated concomitant lesions, while lower case letters indicate untreated concomitant lesions [179].

Other Considerations: The Mason classification has poor intra-observer and inter-observer reproducibility [179]. It fails to consider concomitant lesions, which are present in nearly 80% of multi-fragment fractures [179]. Treatment decisions for radial head fractures are often guided by the Mason-Hotchkiss classification [16]. Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can be given with the best available evidence [81].

Clinical Presentation

Indications and Patient Selection

Radial head arthroplasty serves as a reasonable option for patients with comminuted radial head fractures and complex elbow trauma [1]. It is specifically indicated for acute unreconstructable radial head fractures or as a salvage procedure for previously treated fractures [7]. For radial head fractures involving more than three fracture fragments, which carry a higher rate of failure with surgical fixation, replacement is a good treatment option [35]. In the context of complex elbow dislocations, arthroplasty is the main treatment option, although radial head resection remains a valid alternative [19]. Pyrocarbon radial head prostheses are an acceptable option for unreconstructable fractures [15].

Clinical outcomes favor arthroplasty over other interventions in specific scenarios. Compared to open reduction and internal fixation, radial head replacement reaches better outcomes in Mason type III fractures followed for five years or less [11]. For unrepairable comminuted Mason type III and IV fractures, arthroplasty reports better outcomes regarding elbow stability, range of motion, pain, and fewer complications compared to radial head excision [46]. A radial head prosthesis is a viable option for patients experiencing instability after failed open reduction and internal fixation or radial head resection [45]. Conversely, head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted fractures with neck involvement [16], and a radial head prosthesis appears unnecessary in Mason-IV fracture dislocation [24].

Clinical Outcomes

Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement [13]. Pyrocarbon prostheses yield good functional and radiological outcomes for unreconstructable fractures [15]. Short-term follow-up confirms that arthroplasty with a metal radial head implant is a safe and effective treatment for unreconstructible fractures [49]. Long-term stability of clinical outcomes is confirmed, with no relationship between worsening radiological appearance and clinical results [33]. Survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation [26].

Clinical and radiologic outcomes, as well as complications leading to reoperation, were not significantly different between isolated radial head fractures and associated radial head fractures [40]. However, bipolar and press-fit radial head arthroplasty gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae [66].

Functional Limitations and Return to Activity

Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years [26].

Complications and Risks

The incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature [48]. Anatomic radial head replacement carries a risk of radiographic technical mistakes that correlate to poorer outcomes [22]. If a radial head prosthesis is used, prosthesis oversizing should be avoided as it may contribute to worse outcome with other radiographic abnormalities [39]. Symptomatic loosening after radial head arthroplasty occurs in press fit prosthesis and progressed with tilting manners [109]. Proximal radial neck resorption (PRNR) after press-fit radial head arthroplasty is a common radiological finding that develops in the first 24 months before stabilizing definitively [62]. Secondary osteoarthritis after resection of the radial head is a concern, but it did not affect the functional outcome during the follow-up time in Mason-IV fracture dislocation patients [24].

Imaging and Diagnostic Evaluation

Radiography is validated as the preferred postsurgical modality of imaging, showing a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty [18]. A proportion of radial head and neck fractures are not visible on standard anteroposterior and lateral radiographs of the elbow and are referred to as ‘occult’ fractures [42]. In patients with occult radial head fractures, there is tenderness over the radial head and anterior displacement of the fat pad by haemarthrosis on a lateral radiograph [42].

Aspiration of the haemarthrosis has been proposed to relieve pain and determine whether there is a block to movement that might merit operative treatment for stable isolated fractures [42]. A study of 16 non-displaced radial head fractures found that aspiration reduced articular pressure and provided pain relief (from 5.5 to 2.5 on a 10-point visual analogue scale) [42]. A recent randomised trial found no significant differences in function or pain between patients treated with aspiration only or aspiration alongside injection of local anaesthetic [42]. There is no evidence that examination for a bony block to forearm rotation is reliable or accurate, as it is difficult to distinguish reluctance to move the forearm as a result of pain or a true mechanical block [42].

Preoperative planning relies on radiographic measurements. The radial head arthroplasty diameter can be predicted preoperatively in two-thirds of cases from a simple measurement of the humeral condyle diameter with an appropriate lateral view of a simple radiograph [36]. Our study demonstrates significant radiographic differences between two frequently used radial head arthroplasty implants [4].

Investigations

Plain radiography: AP and lateral radiographs of the elbow are routinely obtained for radial head fractures [35]. Nondisplaced radial head fractures may be diagnosed by elevation of the anterior and posterior fat pads (the sail sign) caused by intra-articular hemarthrosis [35]. The radiocapitellar view is accomplished by positioning the patient as for a lateral view but angling the tube 45° toward the shoulder [35]. Radiography is validated as the preferred postsurgical modality of imaging due to a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty [18].

CT: CT can delineate the location, number, and size of fragments and is rapidly emerging as a standard imaging method for more complicated radial head fractures [35]. CT scans are useful to rule out subtle coronoid fractures that may necessitate operative intervention in the setting of radial head fracture with associated ulnar-humeral dislocation [72].

Other Considerations:

Preoperative Planning and Sizing: Radial head diameter measurements showed excellent reliability, suggesting that the excised radial head, when available, should be used to select the implant diameter [181].

Intraoperative Assessment: The stability of the elbow and forearm should be evaluated fluoroscopically with varus, valgus, rotational, and axial stress tests before and after radial head excision [32]. A fluoroscopic examination is required to rule out concomitant ligament injuries using varus, valgus, rotational, and axial stress tests during open radial head excision [32]. Intraoperative visualization of a gap in the lateral ulnohumeral joint is a reliable indicator of overlengthening following the insertion of a radial head prosthesis [76]. Prosthetic radial head height appears 2.2 ± 0.4 mm more proximal than the coronoid lateral edge on anteroposterior fluoroscopy when the articular surface is even with the coronoid [86]. It was not possible to consistently insert radial head prostheses anatomically [50].

Postoperative Radiographic Findings: There is no relationship between worsening radiological appearance and clinical outcomes in long-term stability of radial head arthroplasty [33]. Neither radiographic landmark is sufficiently reliable to adequately assess radial head prosthetic overlengthening [133]. The radiographic measurement method of Athwal et al. can be used to estimate and diagnose the magnitude of overlengthening of the MoPyC radial head prosthesis, although sensitivity is limited (76%) for small overlengthening of 1.5 mm [184]. A 3D evaluation technique provides an accurate and precise method for assessing prosthesis placement in radial head arthroplasty with minimal measurement errors [175].

Treatment

Non-Operative

Nondisplaced and minimally displaced radial head fractures are managed non-operatively with early mobilization [78]. Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [156]. Most radial head fractures can be managed nonsurgically with early motion, while complex fractures associated with elbow instability require careful selection between open reduction and internal fixation and arthroplasty [82].

Operative

Indications: Radial head arthroplasty is an excellent option for restoring radiocapitellar contact and elbow stability in the setting of an irreconstructable radial head and neck fracture [43]. It is recommended for comminuted fractures with satisfactory medium- and long-term results [77] and serves as an effective treatment modality for comminuted radial head fractures that are unreconstructable with ORIF [88]. Having more than three fragments and loss of cortical continuity of one of the fragments are negative predictors for a successful outcome after fixation, supporting the use of arthroplasty [88]. The procedure is a viable option for patients with instability after failed ORIF or radial head resection for radial head fractures [45] and is an appropriate way of dealing with radial head fracture in combination with elbow instability [130]. Radial head arthroplasty is recommended for unstable elbows, whereas resection is preferable if the elbow is stable [44]. It remains the main option for the treatment of complex elbow dislocations, although resection could be a valid treatment in this group [19]. Partial radial head arthroplasty may be a viable option for restoring joint congruity and could be considered for young patients with a partial radial head deficiency [8]. The intraoperative decision to fix or replace the radial head is critical to optimize treatment outcomes [67].

Implant Selection: Current prostheses include unipolar or bipolar implants, press-fit ingrowth or cemented stems, and non-anatomical (spherical) or anatomical heads [88]. Most surgeons choose unipolar implants for traumatic indications due to the potential instability of a bipolar implant, although some surgeons use them claiming better radiocapitellar tracking [88]. Silicone implants are no longer used due to adverse effects [88]. Bipolar-cemented implants show lower revision rates [77]. Due to the variety of implant designs and limited evidence, current data provide no evidence for a specific radial head prosthesis design [47]. Implant fixation type does not appear to affect functional outcomes of radial head arthroplasty [34]. Surgical implantation of personalized radial head prosthesis produced with 3-dimensional printing technology is a treatment modality with easy application, short operating time, and good functional results [104]. None of the prostheses functioned as well as the native radial head, suggesting that open reduction and internal fixation to restore radial head anatomy is preferable to replacement when possible [70]. A modular metallic radial head arthroplasty system should always be available when operating on displaced radial head fractures because comminution is often more severe than predicted by plain radiographs or CT [121]. In the setting of neck comminution, small plates or cerclage wires should be available to allow for neck reconstruction and the use of a standard prosthesis [121]. A long-stem bipolar prosthesis should be available in the uncommon situation where reconstruction of the radial neck to accept a standard prosthesis is not possible [121]. The author prefers to use a metallic, modular, monopolar smooth-stemmed implant, noting no clinical difference in use of monopolar and bipolar metallic arthroplasty systems and the cost-effectiveness of the monopolar implant [139].

Surgical Approach / Technique: The annular ligament must be sectioned to adequately expose the radial head and neck and to facilitate the prosthesis insertion [80]. Specifically, the proximal third of the annular ligament should be isolated and sharply cut to expose the radial head [139]. All fragments should be removed and then assembled on the back table for sizing [139]. A fresh saw cut at the junction of the head/neck or at the level of the fracture is made to create a stable, straight base [139]. Thorough irrigation is recommended to remove all bony debris to minimize risk of heterotopic ossification [139]. The radial neck can be delivered with a bump under the elbow or with a carefully placed baby Hohmann retractor [139]. The canal can be prepared with a canal finder and subsequent rasps as per manufacturer guidelines [139].

Sizing and Alignment: The size of the radial head prosthesis is selected by comparing the excised radial head fragments [188]. The optimal diameter of a radial head implant is typically the minor diameter of the elliptical native radial head, most commonly 2 mm smaller than the maximum diameter [80]. The implant size is typically downsized one size from the native radial head to avoid overstuffing [139]. When in-between sizes, a smaller prosthesis is chosen both in diameter as well as thickness [80]. If a smooth stem prosthesis is to be used, choose a stem 1 mm smaller than the maximum-sized diameter neck rasp to allow the stem to move slightly in the neck [80]. An implant whose diameter is too large may cause erosion of the lateral trochlea, prevent optimal closure of the annular ligament, and may contribute to residual instability [80].

After placing trial implants, the proximal edge of the prosthesis should sit no more than 1-mm proximal to the corner of the lesser sigmoid notch of the coronoid [139]. The radial head should articulate at the level of the proximal radial ulnar joint which is typically 2 mm distal to the tip of the coronoid [80]. The head must reach the limit between the trochlear notch and the radial notch of the ulna [188]. Any distraction or angulation at the lateral ulnohumeral joint indicates overstuffing [139]. Overlengthening causes the medial ulnohumeral joint to open laterally, but this may not be evident until there is 6- to 8-mm overlengthening of the radial head insert [80]. The review aims to shed light into overlengthening as a complication of radial head replacement and to help identify and treat it [9]. A careful evaluation for congruent tracking of the radial head implant on the capitellum both visually and fluoroscopically is required [80]. If the radial head implant is not tracking optimally with the capitellum during forearm rotation, downsize the stem diameter of a smooth stem implant or reposition the stem of a fixed stem implant [80].

Stability and Closure: A range of motion test and a stability test with manual varus and valgus stress at the elbow in extension should be performed [139]. Following implantation of the final prosthesis, the annular ligament and any concomitant ligamentous injuries should be addressed [139]. After impacting the final components, the lateral ligament complex is repaired with a suture anchor if possible to ensure adequate repair of the ulnar fascicle of the lateral collateral ligament [188]. The annular ligament is closed and stability is assessed [188]. Performing capitellar resurfacing arthroplasty at the time of metallic radial head arthroplasty should be considered when capitellar bone quality is poor [29].

Outcomes and Complications: Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty [166]. Patients with RHA implanted within 4 weeks for nonreconstructable fractures of the radial head sustained a limited number of failures and, despite a relatively high rate of post-traumatic arthritis, obtained a good long-term clinical outcome [163].

Revision: The decision to remove a radial head prosthesis may depend more on surgeon or hospital preferences than on objective problems with the prosthesis [31]. Due to the potential for component dissociation, a bipolar radial head prosthesis may be relatively contraindicated in patients with, or at risk for, persistent elbow instability [126].

Complications

Implant Failure and Mechanical Complications: Mechanical failure remains a significant concern, with implant loosening observed in 4 patients, implant breakage in 2 patients, and prosthesis subluxation in 2 patients within a cohort where almost 40% experienced complications [98]. In the context of total elbow arthroplasty, the incidence of radial head arthroplasty subluxation, dissociation, or implant dislocation was high at 23% [85]. While rare implant-related complications can occur with the MoPyC radial head prosthesis despite satisfactory short-term clinical results [201], higher rates of loosening were seen in salvage cases using anatomic press-fit short-stem radial head replacement with a pyrocarbon bearing [202]. The risk of revision is directly correlated with the implanted radial head diameter [57]; however, individuals who did not undergo a revision by 3 years tend to retain the radial head implant [57].

Stiffness and Functional Limitations: Ongoing severe joint stiffness was the most common cause of complications in a cohort where almost 40% of patients experienced complications [98]. Surgical arthrolysis was performed in 7 patients with ongoing severe joint stiffness following radial head arthroplasty [98]. Similarly, seven patients showed stiffness requiring arthrolysis of the elbow in a study of pyrocarbon unipolar radial head prostheses [140]. Patients who experienced complications and/or underwent revision showed significantly lower outcome variables following radial head arthroplasty [98]. A worse clinical outcome, defined as MEPS < 85 points, significantly increases the risk of not returning to sports after radial head arthroplasty [23].

Nerve Palsy: Postoperative nerve palsies occurred in 2 patients in a study of pyrocarbon unipolar radial head prostheses, consisting of 1 radial deficit and 1 ulnar nerve deficiency [140].

Radiographic and Degenerative Changes: There is a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty [18]. Radiography is validated as the preferred postsurgical modality of imaging for detecting complications after radial head arthroplasty [18]. Long-term follow-up shows high levels of radiologic degenerative changes despite satisfactory clinical outcomes [196]. Significant radiographic differences exist between two frequently used radial head arthroplasty implants, specifically regarding radial neck dilatory remodeling with an uncemented, press fit, fully chemically etched stem design [4]. Proximal radial drift following radial head resection was assessed using radiographic measurements of ulnohumeral joint space and ulnar variance [38].

Other Considerations: Radial head arthroplasty for fractures has a high potential for reoperation within the first year [26]. The highest annual failure rate for monopolar radial head replacement was observed in the first postoperative year [54], and the highest incidence of removal or revision occurred within 2 years after implantation [197]. Most revision procedures for radial head arthroplasty in acute trauma were performed within 2 years after the index operation [98]. Seventy percent of reoperations for radial head replacement in unstable fractures occurred within a year of the initial surgery, with a median time from initial surgery to second surgery of 7 months [173]. A secondary radial head prosthesis significantly increases the risk of not returning to sports after radial head arthroplasty [23].

Silicone radial head prostheses were found to be severely worn in all five patients in a case series of arthroscopic removal [96]. In four of five patients with failed silicone radial head prostheses, the radial head had already fractured [96]. Extensive synovitis was found in all cases, characterized as very rubbery and dense [96]. Histologic examination of synovial tissues showed a hystiocytic foreign body giant cell reaction [96]. All five patients experienced significant relief of pain and mechanical symptoms after removal of the silicone radial head and synovectomy [96]. Flexion contracture improved from a median of 15° to 10°, and the total arc of flexion/extension improved from a median of 110° to 130° after removal [96].

Long-term outcomes for radial head arthroplasty are satisfactory, however, there is a high complication and revision rate resulting in implant survival of 75.1% at 18 years [54]. The overall revision rate was 10.5% in a multi-center study with minimum two years follow-up [198]. Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures [199]. A second operation to revise or remove a radial head prosthesis occurred in 25% of 119 total prostheses in a study of unstable fractures [173]. Removal of the radial head prosthesis was required in 4 patients, with 3 cases attributed to symptomatic loosening and 1 case attributed to breakage of the implant [98]. Secondary osteoarthritis after resection of the radial head is a concern but did not affect functional outcome during the follow-up time in Mason-IV fracture dislocation cases [24]. The modular radial head arthroplasty showed promising findings in short to midterm results [17]. Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low [55]. Clinical and radiologic outcomes and complications leading to reoperation were not significantly different between isolated radial head fractures and associated radial head fractures patients using a cemented bipolar radial head prosthesis [40].

Recovery

Rehabilitation protocol: Early range of motion is essential to prevent stiffness [174]. Immediate active mobilisation is safe and beneficial for Mason 1 and 2 radial head fractures [161]. The use of stem auto-expansion as a mode of obtaining primary fixation in radial head arthroplasty appears to be an effective solution for reducing the risk of painful loosening [169].

Other Considerations: Among active patients with radial head fractures treated with radial head arthroplasty, only about half will return to their preinjury level of function [164]. Three-quarters of these patients will return to active duty military service, push-ups, and sport [164]. However, half may report an adverse outcome unrelated to the prosthesis [164].

Key Evidence

• [L5] Clinical outcome studies of metallic radial head arthroplasty systems indicate that head replacement is a reasonable option to offer patients with comminuted radial head fractures and complex elbow trauma. [1] (10.1016/j.jhsa.2005.12.005)
• [L4] The clinical and radiographic outcomes of revision surgery of radial head prostheses are favorable. [2] (10.1016/j.jse.2016.09.047)
• [L1] The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after radial head arthroplasty. [3] (10.1302/0301-620x.99b12.bjj-2017-0543.r2)
• [L3] Our study demonstrates significant radiographic differences between two frequently used radial head arthroplasty implants. [4] (10.1097/bot.0000000000000876)
• [L3] Longer-term studies will be required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening. [5] (10.1007/s11999-013-3331-x)
• [L4] Younger patients should be counseled regarding the increased risk of requiring further surgery after radial head replacement. [6] (10.1007/s11999-014-3516-y)
• [L4] Metallic radial head arthroplasty yields satisfactory results in acute unreconstructable radial head fractures or as a salvage procedure for previously treated radial head fractures. [7] (10.1016/j.jse.2005.09.010)
• [L5] Partial radial head arthroplasty may be a viable option for restoring joint congruity and could be considered a possibility for young patients with a partial radial head deficiency. [8] (10.1016/j.jses.2017.06.001)
• [L4] The review aims to shed light into overlengthening as a complication of radial head replacement and to help identify and treat it. [9] (10.1007/s00402-020-03619-9)
• [L5] Radial head arthroplasty is a reliable procedure for complex radial head fractures not amenable to reconstruction, particularly when associated with unstable elbows or forearm injuries, provided concomitant injuries are addressed. [10] (10.1016/j.jhsa.2009.01.027)
• [L2] Given the available evidence, radial head replacement appeared to reach better outcomes in patients with Mason type III radial head fractures followed 5 years or less. [11] (10.1007/s00590-013-1367-y)
• [L5] Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement. [13] (10.1016/j.jhsa.2012.10.001)
• [L4] Both surgical removal and revision to a new radial head prosthesis resulted in satisfying outcomes. [14] (10.1016/j.jse.2021.10.043)
• [L4] Radial head arthroplasty with pyrocarbon radial head prosthesis is an acceptable option when treating unreconstructable radial head fractures yielding good functional and radiological outcomes. [15] (10.1111/ans.12908)
• [L3] [16] (10.1177/17585732241255952)
• [L4] The modular radial head arthroplasty used in this study showed promising findings in short to midterm results. [17] (10.5812/traumamon.20201)
• [L4] The study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty, validating radiography as the preferred postsurgical modality of imaging. [18] (10.2214/ajr.11.7674)
• [L4] Although radial head resection could be a valid treatment in this group of patients, radial head arthroplasty would remain as the main option for the treatment of these lesions. [19] (10.1016/j.injury.2020.02.028)
• [L3] Anatomic radial head replacement has a risk of radiographic technical mistakes that correlate to poorer outcomes. [22] (10.1016/j.jseint.2026.101671)
• [L3] A secondary radial head prosthesis and a worse clinical outcome (MEPS < 85 points) significantly increase the risk of not returning to sports after radial head arthroplasty. [23] (10.1016/j.jse.2019.03.014)
• [L4] Secondary osteoarthritis after resection of the radial head is a concern, but it did not affect the functional outcome during the follow-up time. [24] (10.1080/17453674.2017.1293440)
• [L5] Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. [25] (10.1016/j.jhsa.2021.11.006)
• [L4] Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. [26] (10.1016/j.jhsa.2023.04.020)
• [L5] Adequate knowledge of the surgical indications, types of implants, and surgical technique are essential for a satisfactory outcome when a radial head prosthesis is used for the treatment of nonreconstructable radial head fractures. [27] (10.5435/jaaos-22-10-633)
• [L4] The anatomical parameters of the proximal radius of each case and the radial head implant specifications should be assessed when selecting a radial head implant. [28] (10.1007/s00264-015-2773-z)
• [L4] Performing capitellar resurfacing arthroplasty at the time of metallic radial head arthroplasty should be considered when capitellar bone quality is poor. [29] (10.1016/j.jse.2007.04.009)
• [L4] Implant removal is a viable treatment strategy for failed radial head arthroplasty with good outcomes at average 7-year follow-up. [30] (10.1016/j.jse.2026.07.022)
• [Paper] The decision to remove a radial head prosthesis may depend more on surgeon or hospital preferences than on objective problems with the prosthesis. [31] (10.1016/j.injury.2016.02.023)
• [L4] This study confirms the long-term stability of the clinical outcomes of radial head arthroplasty, with no relationship between worsening radiological appearance and clinical outcomes. [33] (10.1016/j.otsr.2021.102818)
• [L1] Implant fixation type does not appear to affect functional outcomes of radial head arthroplasty. [34] (10.1016/j.jse.2018.07.032)
• [L4] The radial head arthroplasty diameter can be predicted preoperatively in two-thirds of cases from a simple measurement of the humeral condyle diameter with an appropriate lateral view of a simple radiograph. [36] (10.1016/j.jse.2018.01.017)
• [L4] [38] (10.1016/j.jse.2010.11.008)
• [L3] If a radial head prosthesis is used, prosthesis oversizing should be avoided as it may contribute to worse outcome with other radiographic abnormalities. [39] (10.1007/s00264-014-2478-8)
• [L4] Clinical and radiologic outcomes and complications leading to reoperation were not significantly different between isolated radial head fractures and associated radial head fractures patients. [40] (10.1016/j.jse.2024.09.025)
• [L5] [42] (10.1302/0301-620x.95b2.29877)
• [L3] Radial head resection is preferable if the elbow is stable due to being less demanding and cheaper, while replacement is recommended for unstable elbows. [44] (10.1007/s00264-014-2594-5)
• [L4] Clinically and radiographically, our results are similar to those reported in the literature, and suggest that in the short term, radial head prosthesis is a viable option for patients with instability after failed ORIF or radial head resection for radial head fractures. [45] (10.1080/17453670510045516)
• [L4] Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. [46] (10.1155/2018/4020625)
• [L4] Due to the variety of implant designs and limited evidence, the current data provide no evidence for a specific radial head prosthesis design. [47] (10.1302/2058-5241.4.180099)
• [L4] The incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature. [48] (10.1016/j.jse.2020.01.086)
• [L4] At the time of short-term followup, arthroplasty with a metal radial head implant was found to have been a safe and effective treatment option for patients with an unreconstructible radial head fracture; however, long-term follow-up is still needed. [49] (10.2106/00004623-200108000-00010)
• [L5] It was not possible to consistently insert radial head prostheses anatomically. [50] (10.1016/j.jse.2007.12.008)
• [L5] Whether there is a significant clinical advantage of a more anatomically shaped radial head implant requires additional study. [52] (10.1016/j.jhsa.2017.05.028)
• [L4] The preferred treatment for failed radial head arthroplasty depends mainly on the chondral condition and stability of the elbow joint. [53] (10.1302/2058-5241.5.190055)
• [L3] Long-term outcomes for radial head arthroplasty are satisfactory; however, there is a high complication and revision rate, resulting in implant survival of 75.1% at 18 years with the highest annual failure rate observed in the first postoperative year. [54] (10.1016/j.jse.2020.11.031)
• [L2] Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. [55] (10.1177/1758573219850111)
• [L4] Risk of revision is directly correlated with implanted radial head diameter, and individuals who did not undergo a revision by 3 years tend to retain the implant. [57] (10.1016/j.jse.2022.09.024)
• [L3] Proximal radial neck resorption (PRNR) after press-fit radial head arthroplasty is a common radiological finding that develops in the first 24 months before stabilizing definitively. [62] (10.1302/0301-620x.105b8.bjj-2022-0817.r2)
• [L4] Bipolar and press-fit radial head arthroplasty gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae. [66] (10.1302/0301-620x.99b9.bjj-2016-1043.r2)
• [L5] The intraoperative decision to fix or replace the radial head is critical to optimize treatment outcomes. [67] (10.1016/j.hcl.2004.06.003)
• [L5] However, none of the prostheses functioned as well as the native radial head, suggesting that open reduction and internal fixation to restore radial head anatomy is preferable to replacement when possible. [70] (10.2106/00004623-200112000-00010)
• [L5] Intraoperative visualization of a gap in the lateral ulnohumeral joint is a reliable indicator of overlengthening following the insertion of a radial head prosthesis. [76] (10.2106/jbjs.j.00356)
• [L4] Radial head replacement is recommended for comminuted fractures with satisfactory medium- and long-term results, though bipolar-cemented implants show lower revision rates. [77] (10.1016/j.injury.2013.09.019)
• [L5] Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. [78] (10.1530/eor-24-0035)
• [L1] Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can now be given with the best available evidence. [81] (10.1016/j.injury.2013.04.003)
• [L5] Most radial head fractures can be managed nonsurgically with early motion, while complex fractures associated with elbow instability require careful selection between open reduction and internal fixation and arthroplasty. [82] (10.5435/00124635-200707000-00003)
• [L4] The incidence of radial head arthroplasty subluxation, dissociation, or implant dislocation was high (23%). [85] (10.1016/j.jse.2021.10.007)
• [L5] Prosthetic radial head height appears 2.2 ± 0.4 mm more proximal than the coronoid lateral edge on anteroposterior fluoroscopy when the articular surface is even with the coronoid. [86] (10.1016/j.jse.2016.04.014)
• [L5] [88] (10.1177/1758573219876921)
• [Paper] The kinematics of the elbow joint deviated increasingly from the native joint kinematics with a +2 mm to a +4 mm radial overlengthening. [91] (10.1016/j.jseint.2024.08.030)
• [L5] [92] (10.1016/j.medengphy.2004.04.011)
• [L5] The kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius. [93] (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
• [Paper] However, a few degrees or mm changes in elbow kinematics could potentially increase stress to the interosseous membrane and contact pressure within the joint, and evaluation of these parameters are encouraged. [94] (10.1016/j.jseint.2024.08.031)
• [L4] [96] (10.1007/s00167-009-0796-y)
• [L4] [98] (10.1016/j.jse.2023.05.012)
• [L5] Proper balancing and adequate bone resection from radial head is mandatory for obtaining normal elbow kinematics during the radial head arthroplasty procedure. [101] (10.1007/s00402-006-0164-z)
• [L4] Surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results. [104] (10.1016/j.jse.2022.10.010)
• [L4] Symptomatic loosening after radial head arthroplasty occurs in press fit prosthesis and progressed with tilting manners. [109] (10.1016/j.jseint.2025.101580)
• [L5] However, the kinematics of the radiocapitellar joint are different after bipolar arthroplasty than in the normal elbow, with abnormal positioning of the prosthetic radial head in supination and evidence of insufficient intraprosthetic motion. [110] (10.1016/j.jse.2009.09.015)
• [L5] The ligaments have the most marked influence on stability, particularly when the upper limb is positioned such that valgus and varus gravity loads are applied to the elbow. [114] (10.1016/j.jse.2004.09.034)
• [L4] Joint stability is achieved and secondary complications like valgus elbow deformity and proximal radial migration are prevented. [122] (10.1055/s-2008-1038333)
• [L4] Achieving full stability of the elbow and avoiding overstuffing are necessary to prevent this complication. [123] (10.1016/j.otsr.2010.02.015)
• [Case_report] Due to the potential for component dissociation, a bipolar radial head prosthesis may be relatively contraindicated in patients with, or at risk for, persistent elbow instability. [126] (10.1016/j.jse.2008.02.020)
• [L5] This study found no statistical differences in radiocapitellar joint contact mechanics as measured by 3-dimensional joint congruency among the three implant geometries in cadaveric specimens undergoing continuous simulated forearm rotation. [129] (10.1016/j.jhsa.2017.03.009)
• [Paper] Operation with radial head prosthesis after fracture of the radial head in combination with elbow instability is an appropriate way of dealing with this problem. [130] (10.1007/s00402-005-0032-2)
• [L5] The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure; however, different patterns of contact pressure and area curves during elbow flexion-extension were observed. [131] (10.1016/j.jhsa.2018.08.005)
• [L4] Neither radiographic landmark is sufficiently reliable to adequately assess radial head prosthetic overlengthening. [133] (10.1016/j.jse.2026.06.024)
• [L4] [140] (10.1016/j.jse.2021.05.017)
• [L4] A single component would suffice for right and left elbows, but a perfectly conforming prosthesis is practically impossible due to large variations in normal anatomy. [144] (10.1016/j.jse.2004.10.012)
• [L4] A nonparallel medial ulnohumeral joint space may suggest overstuffing, but comparing radiographs of the uninjured elbow is the best investigation when overstuffing is suspected. [147] (10.1016/j.jhsa.2007.02.024)
• [L4] The overall midterm outcome of this series of 30 press-fit bipolar radial head arthroplasties can be considered favorable. [148] (10.1016/j.jse.2016.02.007)
• [L5] The measured landmarks show no consistent rotational relationship with the maximum diameter of the radial head. [153] (10.1016/j.jse.2013.02.013)
• [L4] Significant differences were found between 3D and 2D lateral measurements, which highlights the benefits of computer-assisted modeling for analyzing proximal radial geometry. [155] (10.1016/j.jhsa.2025.03.023)
• [L1] Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications. [156] (10.1186/s13018-024-05039-6)
• [L1] This study demonstrated the safety and early benefit of immediate active mobilisation in Mason 1 and 2 radial head fractures. [161] (10.1016/s0020-1383(02)00164-x)
• [L4] However, patients with RHA implanted within 4 weeks for nonreconstructable fractures of the radial head sustained a limited number of failures and, despite a relatively high rate of post-traumatic arthritis, obtained a good long-term clinical outcome. [163] (10.1016/j.jse.2025.06.026)
• [L4] Among active patients with radial head fractures treated with RHA, three-quarters will return to active duty military service, push-ups, and sport; however, half may report an adverse outcome unrelated to the prosthesis and only about half of patients will return to their preinjury level of function. [164] (10.1016/j.jhsa.2017.04.005)
• [L3] Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. [166] (10.1016/j.jse.2017.06.031)
• [L1] The use of stem auto-expansion as a mode of obtaining primary fixation in radial head arthroplasty appears to be an effective solution for reducing the risk of painful loosening. [169] (10.1007/s00264-018-4070-0)
• [L5] [173] (10.1097/corr.0000000000000913)
• [L5] Early range of motion is essential to prevent stiffness, and severely comminuted fractures not amenable to fixation should be managed with radial head replacement. [174] (10.1016/j.hcl.2007.01.009)
• [Paper] This 3D evaluation technique seems to provide an accurate and precise method for assessing prosthesis placement in radial head arthroplasty with minimal measurement errors. [175] (10.1016/j.jseint.2024.08.057)
• [L4] [179] (10.1016/j.otsr.2015.06.026)
• [L5] Radial head diameter measurements showed excellent reliability, suggesting that the excised radial head, when available, should be used to select the implant diameter. [181] (10.1016/j.jse.2013.04.005)
• [L5] The radiographic measurement method of Athwal et al. can be used to estimate and diagnose the magnitude of overlengthening of the MoPyC radial head prosthesis, although sensitivity is limited (76%) for small overlengthening of 1.5 mm. [184] (10.1007/s00402-019-03187-7)
• [L4] [188] (10.1016/j.jse.2011.01.032)
• [L4] [189] (10.1016/j.jse.2003.11.007)
• [L4] Our systematic review established that RHA results in satisfactory clinical outcomes and modest complication and revision rates at long-term follow-up, despite high levels of radiologic degenerative changes over the same period. [196] (10.1016/j.jse.2021.03.142)
• [L1] The highest incidence of removal or revision occurred within 2 years after implantation, with no major difference in incidence among different designs and materials. [197] (10.1016/j.jhsa.2017.08.031)
• [L4] The overall revision rate was 10.5%. [198] (10.1007/s00590-021-02979-1)
• [L3] Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. [199] (10.1177/1558944719837691)
• [L4] Whereas clinical short-term results of the MoPyC radial head prosthesis are satisfactory, rare implant-related complications can occur. [201] (10.1016/j.jse.2016.11.004)
• [L4] The implant should be used with caution in salvage cases, due to higher rates of loosening seen in this cohort. [202] (10.1177/17585732211024182)

See Also

• Radial Head Fracture
• Ligament Injuries
• Elbow Instability
• Elbow Arthroplasty

References

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[4] Radial Neck Dilatory Remodeling After Radial Head Arthroplasty With an Uncemented, Press Fit, Fully Chemically Etched Stem Design. Journal of Orthopaedic Trauma. 2017. DOI: 10.1097/bot.0000000000000876

[5] Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3331-x

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[8] Partial radial head arthroplasty: two case reports with minimum 8-year follow-up. JSES Open Access. 2017. DOI: 10.1016/j.jses.2017.06.001

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[16] Head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted radial head fractures with neck involvement. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241255952

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[23] Low return-to-sports rate after elbow injury and treatment with radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.03.014

[24] A radial head prosthesis appears to be unnecessary in Mason-IV fracture dislocation. Acta Orthopaedica. 2017. DOI: 10.1080/17453674.2017.1293440

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[29] Radiocapitellar hemiarthroplasty for radiocapitellar arthritis: A report of three cases. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.04.009

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[38] Proximal radial drift following radial head resection. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.008

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