Radial Head Replacement (Arthroplasty) Protocol

A radial head replacement (arthroplasty) is performed to restore the stability of the elbow joint, typically following a complex, comminuted radial head fracture that cannot be repaired. Because the radial head is a primary stabilizer against valgus and axial forces, early mobilization is critical to prevent joint stiffness while protecting healing ligaments or surrounding tissues. This phase-based protocol outlines a progressive rehabilitation pathway designed to restore full elbow function, range of motion, and strength while ensuring long-term joint stability.

Phase I: Early Motion & Protection (Weeks 0-2)

• Goals:
• Protect the surgical site and the implant.
• Minimize pain, inflammation, and swelling.
• Initiate early, controlled active-assisted and active range of motion (ROM) within a safe zone.
• Maintain mobility of the shoulder, wrist, and fingers.
• Precautions & Restrictions:
• Wear the posterior splint or hinged elbow brace as directed by the surgeon (often locked at 90 degrees, except during exercises).
• Avoid varus or valgus stress to the elbow joint.
• No active elbow extension against gravity or resistance if the triceps was affected.
• No lifting, pushing, or pulling with the affected arm.
• Suggested Exercises:
• Active and passive ROM of the fingers, wrist, and shoulder to prevent distal and proximal stiffness.
• Gentle active-assisted and active elbow flexion and extension in a pain-free range (typically 30° to 130° initially, progressing as tolerated).
• Forearm rotation (pronation and supination) performed with the elbow flexed at 90 degrees. If lateral collateral ligaments (LUCL) were repaired, supination may be restricted or performed in pronation; follow specific surgeon instructions.
• Gripping exercises (putty or soft ball) to maintain hand strength and manage swelling.
• Criteria to Progress:
• Decreased pain and swelling.
• Elbow flexion to at least 110 degrees and extension to within 30 degrees of full extension.
• Wrist and hand ROM fully maintained.

Phase II: Active Motion & Progressive Mobility (Weeks 2-6)

• Goals:
• Achieve full or near-full active range of motion (ROM) in flexion, extension, pronation, and supination.
• Progressively discontinue the use of the brace (under surgeon guidance).
• Emphasize proper movement patterns and prevent compensatory shoulder/wrist movements.
• Precautions & Restrictions:
• Avoid heavy lifting, pushing, or pulling (nothing heavier than a coffee cup, ~1-2 lbs).
• Avoid sudden or jerky movements.
• Avoid aggressive terminal stretching or forcing of range of motion.
• No weight-bearing through the affected arm (e.g., pushing up from a chair).
• Suggested Exercises:
• Continued active and active-assisted elbow ROM, aiming for symmetric extension and flexion.
• Progress active forearm pronation and supination to tolerance, maintaining the elbow flexed at 90 degrees.
• Gentle passive stretching at end-range (extension and flexion) if approved by the surgeon, using low-load, long-duration techniques.
• Submaximal isometric elbow flexion, extension, and forearm rotation (starting around week 4-5) if pain-free.
• Scapular stabilization and gentle shoulder strengthening (rotator cuff exercises) using light resistance bands.
• Criteria to Progress:
• Active elbow ROM: flexion to 130 degrees, extension to within 15 degrees of full.
• Functional pronation and supination (at least 60-70 degrees each way).
• Minimal or no pain with basic daily activities.

Phase III: Early Strengthening & Activity Progression (Weeks 6-12)

• Goals:
• Restore normal, pain-free strength of the elbow flexors, extensors, pronators, and supinators.
• Improve muscular endurance and joint stability.
• Gradually reintegrate the arm into light activities of daily living (ADLs).
• Precautions & Restrictions:
• Avoid high-impact activities or sudden load transfers.
• No heavy lifting (limit to 5-10 lbs until week 12).
• Stop any exercises that provoke sharp joint pain or clicking.
• Suggested Exercises:
• Progressive resistance exercises for elbow flexion and extension using light dumbbells (starting at 1-2 lbs) or resistance bands.
• Dynamic forearm pronation and supination exercises using a hammer or weighted bar.
• Progressive wrist strengthening (flexion, extension, radial/ulnar deviation).
• Closed-kinetic chain exercises (e.g., wall push-ups, light weight-bearing on a table) to improve joint proprioception.
• Eccentric strengthening of the elbow and forearm muscles.
• Criteria to Progress:
• Full active ROM compared to the contralateral side.
• Good strength (at least 4/5) in elbow flexion, extension, and forearm rotation.
• No pain or instability during daily tasks or basic resistance exercises.

Phase IV: Advanced Conditioning & Return to Sport/Work (Weeks 12+)

• Goals:
• Optimize multi-planar strength, power, and endurance.
• Restore full functional capacity for work, sports, and recreational activities.
• Implement a maintenance home exercise program.
• Precautions & Restrictions:
• Gradually increase loads; do not jump to heavy lifting or high-impact activities suddenly.
• Wear protective bracing if returning to high-risk contact sports, and only if cleared by the surgeon.
• Suggested Exercises:
• Advanced strengthening exercises (e.g., biceps curls, triceps press-downs, pull-downs, push-ups).
• Plyometric elbow exercises (e.g., medicine ball tosses and catches) for athletic patients.
• Sport-specific or work-specific training drills (e.g., throwing progression, tool handling).
• Continued stretching and mobility maintenance program.
• Criteria to Progress:
• Surgeon clearance for full, unrestricted activity.
• Elbow strength at least 90% of the uninjured side.
• Complete confidence in joint stability and function during high-demand activities.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.