Elbow Elbow dislocation, considering TJR

Pairodocs

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Hi, I'm really hoping there are at least a few others with elbow replacements out there. Is Liam2015 still on the forum?
I fell and dislocated my rt elbow, tore ligaments and crushed the coronoid bone in April 2021. The ER doc sent in a script for ibuprofen, rather than an opiod. I didn't know until hubby got to pharmacy. Level 10 pain, ibuprofen doesn't help and tylenol doesn't work for me at any time. I started with aspirin but the pain was so great that I soon lost track of how many I was taking. I don't remember any of it but I ended up in ICU for 5 days with aspirin overdose and potential kidney failure. I didn't even know you could overdose on aspirin and thankfully the kidney problem resolved as my system was flushed.. I won't go into how incompetent the hospital was, but after I was moved to a regular room for another 5 days, I felt I wasn't getting better so checked myself out. They had done nothing with my elbow but wrap it up. They weren't helping me get stronger (have had lots of OA operations and time in hospital, I knew what I should have been able to do by when). They had such a huge cast on my arm that I overbalanced, fell and dislocated my rt hip a day after getting home. this time we drove to big teaching hospital who checked me in and scheduled hip revision next day and elbow surgery for 4 days later. All that time that the first hospital didn't do anything with my elbow, the bone ends were softening so the first surgery didn't take. Month later, we tried external fixation but I fell right on it and broke the ulna. Since it was held in place by the fixation cage, it completely healed. I had to have a knee revision (unstable, reason I was falling) and another hip revision over the next year.

In the meantime, the ligaments on the elbow have grown and healed but OA has set into the joint. Just saw my elbow Orth who said it was my decision. My condition justified a TER, but Orthos prefer to do them on 85 yr olds in electric wheelchairs that don't lift more than a book. I'm a 67 yr old active who plans to still be active by 85. I can't straighten out the arm and can't rotate more than 85 degrees out of 180. There is pain in the elbow (3-4) nearly all the time and anything like typing tires the muscles out and everything stiffens up. I've had to stop and rest twice while typing this.

I'm told TER are strong prothesis but unlike knee or hips, the metal is stronger than the bone so the problem isn't dislocation, it's the stem breaking through the bone. I'm terribly right handed and can't imagine not using my arm for anything than just carrying 1-2 pounds. That's not even a gallon of milk. And what about turning a door handle, handling a steering wheel, pulling weeds, and the million other things we do in a day. This is a bigger decision than I have ever had for other joint replacements. It seems like I can still do most things with the elbow in the current position, but there is the pain. Also, my ortho said the current condition of my elbow and status of the OA gives the greatest chance of a successful joint replacement. The worse the OA gets, the less likely everything will fixate well. So if I wait until the pain is unbearable, the bone might not be as strong and the greater chance that the replacement won't work. My Ortho says that unlike other joint replacements, there really isn't a backup plan for elbow replacements other than stuff in cadaver bone and hope everything heals right.

I'm really hoping there is another person out there with a TER out there that can give me some idea of how this works out so I'd have more information to make a decision on.
 

djklaugh

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@Pairodocs Welcome to BoneSmart1 Alas we have not seen many folks needing elbow replacement here and the few we have seen have not been active for several years. I am going to ask my colleagues if they have any additional information for you.

It does sound, from what you wrote, that the replacement needs to happen soon in order to preserve functioning of the elbow.

Did the ER doc on your initial visit following the elbow injury not take xrays? I am rather appalled that nothing was done at that time to assess the damage done to your elbow! My son had a compression fracture of his left elbow years ago - skiing accident where he went elbow first into a tree. And ER visit at that time did take xrays and put him in a cast. He was fortunate to come out of that with no lingering problems. He's a lefty and was hoping to get out of school work ... mean Mom though made him do all his work in his head and dictate it to me. He did get better grades that term but only I think because my handwriting was neater and I was a better speller.
 

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Hello @Pairodocs. I am so sorry for all that you have been through ~ what a terrible ordeal. I had ORIF surgery for my broken elbow and 4 weeks later I fell on the incision last day of vacation in Jamaica. Luckily everything was ok but I regressed and pain was back for awhile. Now, years later, I have no pain and have r.o.m. back. However, 16 months ago, Dec. 2020, I broke my femur right above my left TKR (had ORIF) and I'm still limping and have to hold on to handrails going up and down stairs. I use a hiking pole if necessary outdoors. The knee replacement was not harmed and I have that r.o.m. adequate.
Luckily my elbow healed well, no complications, and I was able to ride my city bike outdoors and we even planned a bike/barge tour in Europe for Apr. 2021 just before pandemic was announced so we cancelled (broke femur before we were originally due to go).
Again, I'm so sorry for what you're going through. I don't understand all the terminology so I can't give any advice other than to search for the best dr. to guide you. Best wishes to you.
 

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Hi, @Pairodocs .... I'm so sorry to hear about all you've been through. I hope you're giving serious consideration about going ahead with the elbow replacement surgery. The key to me is the fact that things only have the potential to get worse if you wait. Arthritis is a mean bear that way....it has no cure and only advances with time.

Even though we don't have a lot of members who are or have been through this surgery, we can still be a good support resource for you. The important thing in all this is something you've already done - locate an excellent surgeon who clearly understands your problem and will help you work to make things better. We want to see you active at 85 also!

So, stick with us and let us know how things are going. I'll be watching your thread here for updates and hope to hear more from you soon. You can be one of the charter members in our BoneSmart Elbow Club. :egypdance:
 
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Pairodocs

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Hi everyone, thank you so much for responding. I can answer some of the questions. I didn't go into the trip to the ER much because my husband wants to sue. Yes the ER doc took x-rays but apparently misread them. He didn't mention the crushed coronoid bone which my elbow surgeon saw in 3 secs. At least he didn't mention it. I don't know if he really understood that ligaments were torn etc but he certainly acted like lets just wrap it and get her out of here. He also didn't want to prescribe a high enough pain medication for that type of injury but with the new opiod laws, I don't know if he can be held to account for that.


To Liam2015: Thank you so much for replying. I'm not sure how much our situations are alike after your description, but I'm so glad your situation has turned out well for you. Looking up ORIF, the abbreviation is for broken bones, but sounds like it doesn't have to be a dislocation. So my question for clarification is do you remember which bone was broken? and was the joint actually taken cut out and a metal joint put in? With two broken bones have they mentioned osteoporosis to you? Did they put any restrictions on weight you could carry in your hand? or pressure you could do in pulling or pushing things?

We are alike in that when I had the external fixation cage on, I fell right on it as well a month later. It broke right in the middle of the ulna. It hurt at first but I was fed up with hospitals and just emailed my surgeon. Since I already had a followup scheduled 5 days later she didn't tell me to go to the ER. It was at the appt that xray showed the break, but the fixation wires and stems had kept everything in place as if it had already been set. so it healed just fine. My main problem was the ligaments were torn and with the coronoid process crushed, there was nothing to hold the joint together and it kept slipping apart. Apparently the softening bone was the main problem. I had no idea bones did that when not fixed to each other and I don't understand how they don't soften when just a stem is put in for a joint replacement. I'll have to ask that question next appt.
 

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Let me tag @liam2015 2015 to be sure she gets a notification that you've asked some questions.

Wow.....this is quite a situation you're in. I'm so sorry all this has happened to you and hope you can get to a better place soon. What is your surgeon recommending for you?
 
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Pairodocs

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It's taken me awhile to get back online. I talked with my rheumatologist and she agreed that I could try methotrexate to slow down the OA. Methotrexate is a once a week dose but you have to take daily folic acid with it. I was really hopeful although it has a long list of side effects, some critical. I had to have liver tests at 2 and 4 wks to make sure it wasn't affecting my liver, a serious side effect I started having stinging pain in my damaged elbow within 3 days of the first dose and in my good left wrist a couple of days later, then a spot on the side of my rt knee. I thought all of these weird pains were due to stopping the Plaquenil. Then last Monday was my 2nd dose of Methotrexate. Yesterday I had a ulcer at the bottom of my lower front teeth. This morning it was larger so it was off to goggle to check side effects again. Sure enough, stinging and mouth ulcers are on the side effect list. I called my rheumatologist and she said the mouth ulcers were due to not enough folic acid. She said she had never had a patient with those two side effects, they are suppose to be rare, so she didn't want to take any chances of continuing the medication. So there goes my only chance of slowing down the OA. I have to double the folic acid pills for the next week, not take the Methotrexate again and can start the Plaquenil next Monday. The mouth ulcers are apparently worrisome and she wanted me to keep her up to date if they didn't go away in a few days.

I had talked with my elbow surgeon last week to let her know what I was doing. She is trying to find someone that was under 70 who had been through an elbow replacement and was willing to talk with me. She suggested keeping a diary of the actions that I can't do or which cause pain with the current state of my elbow. Also keep a diary of actions that I wonder if I might still be able to do with the TEP (total elbow replacement). The next appt we could go over them and she could give an idea if the replacement would solve those particular pains and if she thought I would be able to do the 2nd list of actions. So that is where I am. Surgery is still scheduled for July 12th.

My surgeon said the main problem was the metal stem was stronger than the humerus and it would break at the top of the stem. My husband has an engineering mind. His first thought was why couldn't they put a metal ring around the bone just below the top of the stem. Wouldn't that add strength to the humerus. I don't know which bone in the lower arm, ulna or radius, that the lower stem would go into or if a metal ring could be put around that one. What do you think?
 

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Bless your hubby for trying to come up with something to help! It wouldn't hurt to ask your surgeon about that. The idea actually makes sense to me....sort of like the cerclage wire used with hip replacements sometimes.

You are forging new ground here for us with your elbow issues and, while it's difficult for us to provide much advice or information to you, your documentation of what is going on will help us and others. So, I really appreciate it.
 

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Hi ~ I'm sorry you've had those awful side effects from the Mexotrexate. I can't answer your questions about my broken elbow because I don't exactly know and I don't remember; also I didn't take a photo of the x-ray but I think I have it on a disc I was given. I do know I have hardware in there. It doesn't bother me at all anymore but it's a different situation than you have.

Please do keep us updated as to your progress and what you decide to do regarding the elbow replacement. Your husband has some creative ideas to talk over with the surgeon. Best wishes to you.
 
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Pairodocs

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Well my journey seems to twist and turn. I had stopped the Plaquenil when starting the methotrexate but haven't started it again after stopping the methotrexate. I always feel its good to have a washout period if possible. IT's been 2 wks since stopping the methotrexate and 4 weeks since stopping the Plaquenil. The odd thing, the pain in my elbow has reduced immensely, especially the horrible pain when laying down in bed and taking the lower arm straight up to flat. I had to hold the lower rt arm with my ok left arm to slowly lay the rt arm down. It hurts too much to freely lay it down. Well now off both drugs, my elbow is pain free! I called and asked my rheumatologist if the Plaquenil had been causing increased pain as some medication can do. She says no and wants to see me next week. I can't find anything on the internet at major medical websites that explains it.
 

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That is really odd......I'll be curious to hear what your rheumatologist has to say. Let us know how the appointment goes.
 
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Pairodocs

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I don't see my Rheumatologist for another week, but I thought I had the elbow pain going away figured out. But now maybe not. I have been doing a lot of weeding lately. With all the surgeries last year I had not been able to keep my garden cleaned up so it's a mess with crabgrass and creeping Charlie this year. Creeping Charlie (CC) is easy to pull up, the roots are very shallow and fine. The grass (crabgrass and bermuda grass) are another matter, they put rhizomes down very deep and can take a lot of strength to pullout. Before stopping the Plaquenil and starting the Methotrexate I was trying to pull out a lot of grass which was a lot of stress on my right arm. Then in the time after stopping the Methotrexate I was working in an area with a lot of CC which is very little stress on my arm/elbow. I thought that was the answer.

However, I didn't start the Plaquenil again until Friday (2x/day) and by Saturday night my elbow is hurting again, along with my left shoulder. I haven't been in the garden for the last 5 days, so it isn't the weeding that is causing it. I'm going to stay on the Plaquenil for a week and keep a pain diary, then stop it for a week to see if it makes a difference.

I've put my elbow replacement off until Nov. I do want to get a garden in this year and a lot of other things in the house. So I figure I'll have the winter to recover. This also gives me time to figure out what these RA drugs are actually doing.
 

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