Name: Radial Head Arthroplasty Technique Using a Modular Implant System
Uploaded: 2026-10-08T00:00:00Z
Duration: 15 min 57 s
Channel: Arthrex

Hand and Wrist

Barth Riedel, MD (Pomona, CA), presents a detailed demonstration of the Arthrex Radial Head Arthroplasty System. The system combines a circular, nonanatomic head with either a smooth, free-floating stem or a grit-blasted, press-fit stem. Radial head sizes range from 18 to 28 mm in diameter, and stem sizes range from 5 to 11 mm in diameter. Technical pearls related to exposure, neck preparation, implant sizing, and final implant placement are discussed.
0:00 - 3:02 - Implant and Instrumentation Overview
3:02 - 4:13 - Exposure and Approach
4:13 - 7:22 - Radial Head Resection and Sizing
7:22 - 8:49 - Reaming and Planing
8:49 - 11:00 - Trial Stem and Head Insertion
11:00 - 12:15 - Final Implant Assembly
12:15 - 14:39 - Final Implant Insertion
14:39 - 15:57 - Implant Removal (if necessary)

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VID1-009289-en-US | A | Radial Head Arthroplasty Technique Using a Modular Implant System

Barth B. Riedel

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Radial Head Arthroplasty Technique Using a Modular Implant System

Speaker  This is Doctor Barth Riddle from Pomona, California. It's my pleasure to introduce the Arthrex radial head arthroplasty system and what it looks like specifically on the back table before you get started. So on the top tray, which you'll see on the near side, you'll first see your radial head trials. And the radial head trials are sized from 18 all the way up to a size 28 in even intervals. And then from left to right, the neck is actually built into the height of the head. And so it will start at nine millimeters. Work your way up by 2 to 1113 all the way up to 17. So starting at the bottom, you have a 18 diameter head by nine millimeter height all the way up to a size 28 head by 17mm height, giving you an expansive amount of options to treat your different kinds of patients. The next thing you'll see is the stems, and these are the trial stems. The stem sizes go from size five all the way up to a size 11. So here's a closer look at both the trials as well as the implants on the left. You can see this is a standard size seven width trial stem. Now in case of an emergency, if there's ever too much neck that's either fractured or taken off on top of what you can build into the head and neck. As previously mentioned, there is one more trial stem you can actually do to add six more millimetres, increasing your total offset to 23. Speaker  Again, this is in those cases of bad severe fracture polytrauma where there's a lot of the neck or head that's gone. And you just need this as a backup. The majority of cases that won't be necessary. Looking across and you can see both the grit blasted as well as the smooth stems. And you can see the stem length is longer than the than the trial. And again, this was with purpose to allow for insertion and removing all in the case after you're trialing. The other thing that's important to note is that the trials are also slide locked. So when you put the stem in, the head slides on nicely, which aids in getting them in and out easier during the trialing phase. There's also a Stem apparatus to help pull the stem in and out. There's two lobster claws, and then there's also a head inserter that can screw into the head, easing the ability to put it in and remove it out and keeping your case nice and efficiently moving along. There's also a head impactor that you'll see, as well as an opening all specifics on the opening. All there are laser lines which then allow you to see how deep the all goes, so that you don't have to waste time starting at a low reamer when you can move up sequentially faster on the deep side of the tray. Speaker  You'll start on the left and you can see these gauge heights. These are in a lollipop type design. Moving along, then you have the Calcar Planers. Again, this is important to make the radial neck nice and smooth and flush. We also have this distractor or shoehorn type of tool, which allows you then to lift and pull the radial neck up out of the wound, which gives you a more in-line approach for when you go to the far side and then use these opening reamers and awls, you can use them both in hand-held as well as with power. In between these, you'll find the radial head trial Sizer. One of the more important things in this set, which is imperative to placing an implant, is being able to get it out. And. On the top left you can see that there's two very specific tools. There's a cannulated handle that's meant to screw into the stem, which allows it then to be back slapped and pulled out. There's also a head removal tool which slides in. It will actually help break apart the Morse taper between the head and the stem, thus making extraction of the head easier, followed by the stem. So here we have a standard lateral approach to the elbow. Once you get through the skin, there are several different ways and places to get into the radial head. Speaker  My preferred technique is going between what's called the EDC here and the ECU split. The important thing about this is it actually places you on the anterior one third of the condyle, which will then help protect the lateral collateral ligament complex, which you can see down here. So it's just a fail safe way to get in without destroying too much of the lateral ligament complex. If you go to the next level and elevate these flaps underneath ECU, this is your annular ligament. This smooth material right here. And you can see it on this. So you have to transect the annular ligament to be able to open up the head and neck. And a lot of times we'll release up to about 15mm down the shaft of the radius. This gives you enough space to make your cuts. And still staying distal enough to not resect too much of the radial head and neck. And as you can see, with a simple 6 to 7 centimetre incision, you can get very, very good access and exposure. You can see your head neck flare and the shaft. This is still very much proximal to stay out of the posterior interosseous nerve. Remember to keep the hand pronated during the course of this, just to keep the posterior osseous nerve nowhere near your incision site. And again, the lateral lateral ligament complex is still nice and firmly attached. Speaker  So the next step in the technique is to get your gauge height tool. And what you do is you place the concave surface on the rim of the radial head, and whatever size would fit to where your cut in. The sagittal saw guide here will be at the base of the neck. So for instance, this is a 19 if I put it on the head, I think that's a little too far down the neck. I don't think I need that big of a cut, but the 17 when placed. The sagittal saw line is going to be right at the base of the radial neck. So I like the size. And then from here you just take your k-wire you can place it in. And a good trick is to leave the k-wire in. So when you use this to use your sagittal saw cut, then the K-wire can actually be used as a joystick to pull out the radial head. In cases when you open up for cases of fracture instead of arthrosis, oftentimes you'll have radial head and neck fractures. So once you've taken those pieces out, then you naturally would make your cuts. This depth gauge tool can actually be used. Then just to show your offset of your head and neck. And you don't necessarily need to use it. Then for a sagittal saw cut, oftentimes in the case, I'll have a surgical assistant just put in some soft tissue retractors just to protect the soft tissues around the neck. Speaker  And then again, remembering to keep this parallel to your joint line, you can bring in your sagittal saw and make your cut. And if there's any bit of residual bone on the back side, you can use this pin to rotate. And then you can freehand cut just to get the rest of this release. Once it cuts completed and your corticotomy is all the way through, you can just gently rotate, remove any of the associated soft tissue that's still around the neck. And this should come out fairly easy for you. There you go. After your rail has been resected out. The next step then, is to get out your radial head size or block. And remember, you want to flip this down to the articular side and then see which space this will fit into. So starting at the 26 this is fairly loose. 24 it actually fits fairly snug. And a. 22 it's actually slightly larger. So initially a. 24 would fit. But if you flip this head over, as you'll see in a lot of arthritic elbows, there's actually osteophytic growth around here. So the natural side of the head is actually going to be a little bit smaller than that. So typically for cases of Arthrosis, if it fits in, let's say the 24 head, you want to downsize one head size. Speaker  So for this case specifically we would size match and we're going to choose a 22 head. So initially we made a 17 millimeter cut using the guide. But when we replace the guide back in it actually fairly stiff. This is a little snug. In fact, this is a little too snug for what I would like. So I'm going to take this out and we're going to trial down and place this one more time using the concave surface and the 15 glides in nice and smooth. It's important you want a little bit of give when this goes up and down. Remember, the radial head doesn't always sit flush with the capitellum. It has a millimeter or two of GAP. And so it's important to have a little bit of play in this. When you put in a railhead or else you'll overstuff it. Sometimes when you make your initial cuts, you'll find the cuts fairly smooth. But on the back deep side, there's a little bit of fragmentation and unevenness in the radial neck. So if you see a small little shard of bone there, just take your rangers. Smooth this out. The calcar planer at the end of the case would also serve to smooth that off. But there you go. Now you can see it's nice and smooth. We can get on with the rest of the case. Speaker  The next step in the procedure is to use the starter all again, remember it's laser lined, so you can kind of figure out where you're going to use your reamers later. But the opening all is inserted and just by gently pushing it in, you can see we've already gotten down to the nine millimeter line. You don't want to overdo this, but this gives us a good place to start. So we're going to start with the nine millimeter reamer. So this is the nine millimeter reamer. Again important to note that the stem length is the same length of the reamer. So when you're reaming and this we're just going to do by hand when you ream, you just need to ream to the base of the flutes. And that's the full length of the stem. So again, that's a nine. We're going to sequentially go up because there was not a lot of bite there. This is the ten. And this one being a fairly large radial neck. Looks like we're going to fit an 11 in here. And actually when you put this in this is actually a good size and a fit. So the next step would be to smooth off the surface of the radius. And again we can use our planer. This is a kalker planer. And the stem size of this matches the stem size that we've already reamed. Speaker  There's also a tool, the shoe horn, which you'll find in the set. The nice thing about this is when you turn it to the side, you see there's this divot. This will actually accept the head of the planer when you put this in. The other side is nice and smooth. While you can use this to lift the neck up, you don't want to use this with a planer because the teeth will bite into that. So if we use this tool in shoehorn lifts this up, you can see how it brings up the neck quite nicely. And then this is actually fairly easy to see down. And we can actually get a nice flat plane to make a good surface to accept our radial neck. So once you've done your reaming, you have a nice flat surface on the radial neck. It's time to trial. So remember we trialled a size 11 reamer. So the 11 stem is about half the length of the regular stem to allow it to insert. And you want the collar to sit nice and flush. And if it does, then you know that you've done your reading appropriately, which this does again. The next one we measured a size 22 head with a 15 offset. The natural head has a nine millimeter offset. This is six millimeters built into the neck. And again, it's a side loader. And so you're able to come in from the side and pop right down onto your neck. Speaker  So in the latter of the elbow, this is what you want to find, is that the collar is nice and flush with the radial neck. There's no spacing, no gapping. We did a good planing so we get 360 degree fit on the collar. The second thing is you can see the capitellum, and there's just a small amount of space between the radial head and the capitellum. Again this is very, very important if you don't want to overstuff the joint. One final thought. On the lateral X-rays, you can see where we reamed. And again, the stem that you're going to place is about twice the length of the trial. So you can see that we reamed a size 11. And there's that hollow point in the radial neck. It purposely ends right about the insertion of the biceps tuberosity. That is very purposeful in design. So on the AP of the elbow while the stem fit looks good if you look at the head. The head is actually proximal to the proximal radioulnar joint. Now again, when we talk about impingement, flexion and extension will be severely affected by this. Plus the contour of the radial head doesn't match the pruj. So instances like this. The nice thing about this set is we trial the size 15. So now we're going to pull this out and trial size 13 offset just to see if it matches a little better. Speaker  Note on the AP. The humeral lines on both the ulnar and radial side need to be equal. If you overstuff you'll get pinching on the medial side. So after we shot the AP, we decided then to change the offset on the neck. So we went down from a 15 to a 13. The other thing we did is we replanned the surface of the radial neck, just to make sure it was nice and flush. And as you see with this X-ray, this sits nice and flush, and there's a good space between the radial head and the capitellum. So again, this is now a new AP after we have changed the size of our offset. As you can see, the distal aspect of the radial head is even with the proximal radioulnar joint and the ulnohumeral line is equal throughout the joint. So after you're done trialing, then you can use the head Inserter tool just to gently pull directly back in line with the stem of it. That should pop the head right off. And next is the stem removal. Again, the stem removal set is nice and easy clamps around the neck of this, and it just pulls it right out. Now that we've finished trialing, it's time to put the final prosthetic in the radial head. Always double check to make sure it matches correctly. Speaker  So we trialed the 22 that fits accurately. And then you have two Stem choices. You have both the smooth and the grit blasted. Remember, we purposely made this smooth just a fraction smaller. It's not then what we reamed so that it can slide in quite nicely, whereas the grit blast is essentially line to line the same size you ream. That's the size of the stem that you're putting in. And in this case, I'm going to choose to put in the grit blasted stem. So the implant has a more stable design. So your stem size you find and you place in the hole that's marked. So we chose an 11 stem. This goes in the 11. And then you take the radial head. It goes just straight on top. Up, then use your radial head impactor and while your assistant holds the sizing tool so you. Don't shoot this off into the back of the Or table. Gently but firmly get your more taper. You can see it compresses quite nicely. So while the shoehorn does provide you with better visualization when you're reaming, this will get in the way when you're placing your radial head. So at this point we transition put our lobster claw back on. Assistant gives a little gentle traction. Pull this out and you should have a nice good angle to get your stem in. Again, insertion of the stem is fairly simple. Speaker  Again, with good traction you can start the stem, get it placed, and a lot of times it'll kind of pop in, put your impactor in place, give it a couple good taps, and you want to get that neck and that collar nice and flush. So drop the arm just a little bit now so you can see that that's nice and flush, which it is. And I like that placement. So on the AP of the elbow after we've placed our implant you can see the collar sits flush on the radial neck cut. The radial head aligns very nicely with the proximal radial ulnar joint. It's not too proximal. It's not too distal. It sits well within the groove. And the ulnohumeral line is even throughout going all the way from the medial to lateral side. Important to note as this is a point of discussion, but there is supposed to be about a 1 to 2mm gap on your implant between the collar and the neck of the head. So you can see on this that that's there. This is normal. This is part of the mechanism by which we get the Morse taper design. And this is normal. And what you want to see when you do this. So this is the final lateral radiograph of the elbow. As you can see the radial stem fits nicely down the radial shaft. The collar is again flush in this plane. Speaker  So on 9090 orthogonal views the collar is nice and flat. So once the implant is placed and you're happy with your X-rays, the closure, although it's the end of the case, is actually very, very important. Deep to this tissue. If you flip this over this shiny tissue, that's your annular ligament. It's very, very important. You need to place a stitch or two in a figure eight fashion in this annular ligament, connecting it from this side to this side over here. This is the restraining of the radial head. So it's important to get that together. The second tip when you close up here, if there's a portion of your lateral collateral that's off again, the vast majority is still attached. Or if you just want better fixation, you can definitely put an anchor right here. And then you could purse string this together and then close your super your superficial fascia right here. So after starting to close the capsule in the annular ligament, you can see with pronation and supination, the head sits nice and firm on the capitellum there stem is nice and seated, doesn't rock around in there. And then the neck cut is nice again as the collar sits firmly on it. And finally, with flexion extension, you can get him all the way up to about 145. And then we bring it back in extension it's nice and smooth. Speaker  You get to full extension and good rotation even at full extension. So just to run through the extraction system in case you need to do that, this is the head extraction tool. Again on the distal aspect it's labeled stem and it's also labeled head. That's because you can see it's beveled in a specific plane to help take the head off. So again the side says head. We're going to turn and put it towards the head. Slide this in between the neck and head and gently give it a couple taps and you can see it helps loosen the head up. From this point, you should have enough space then to get the head and get it up out of the wound. There you go. And then the next thing we'll use is our stem removal set. So this has two components to it. The first seeds within the threads of the neck. The second is the screw in portion which actually has a part will bite on the inner side of the radial stem. So this is connected and the tip will come out through the end. As you can see like that. So to get this in the stem, we're going to back this up so that it sits flush with the tip here. Put this in our stem. And now you can use this screw mechanism to tighten up. And it will bite in the stem nicely. And then a few back slaps. You can get the stem out.