Total Elbow Replacement Surgery – One Woman’s Experience

This gives an overview of my experience with total elbow replacement surgery, a 5-hour procedure done by Dr. Douglas Hanel,  March 28, 2008,  Harborview Hospital, Seattle, Washington.

Note:  For those who wish to learn about the medical aspects of this surgery (i.e. step-by-step explanations of the procedure and visuals to accompany the same, explanations of potential risks, information about prosthetic replacement parts, etc.) you may want to research using the technical terms for the procedure:  Total Elbow Arthroplasty and Endoprosthetic Elbow Replacement.

The following overview represents only one experience – my own. In no way do I mean to suggest that others who have this surgery might have an experience similar to mine.

The history of my right arm: At four years of age, I broke my right arm and elbow. When the cast came off, my arm was in a fixed, rigid position, bent at about a 90 degree angle. I was told that 'the doctor left the cast on too long' and 'either did not know how to repair the arm, or was not able to repair it such that I would ever regain full use of it.' That is what I was told, whether that information is correct or not, I cannot confirm.

When the cast came off, my father realized I would be living with a damaged, bent right arm. He also knew I was decidedly right-handed. Consistent with his kind nature, he did all he could to encourage me to 'keep using that arm,' while dismissing my protests, “No, Daddy, it hurts when I move it.”

For years after the cast came off, the pain ranged between a dull ache to occasional extreme, sickening pains that shot through the arm and felt as if I had just broken the arm and elbow – again. The pain was constant and usually somewhere in between those extremes and continued right up until I had the total elbow replacement surgery in 2008.

In his determination to get me to 'keep using that arm,' my father set up a ping-pong table outside in our driveway. We played table tennis often. He insisted that I use my right arm to swing at the ball even though I much preferred to use my pain-free left arm. He encouraged other activities such as going for canoe and rowboat rides on the Chippewa River which flowed at the base of a hill near our home. Quite often, when I left for those rides with my older siblings, he would remind me, ”Use your right arm to paddle and row – you've got to keep that arm limber.” "But Daddy it hurts!" to which he would reply, "Use it anyway."

Thankfully, after a period of time I was able to extend my arm from a 90 degree angle out about 30 degrees. I was never was able to extend it beyond that, nor was I ever able to move it at all, in the opposite direction. Still the range of motion I achieved was an outstanding improvement which proved most helpful for all the years to follow.

Through the years I graduated college, married, raised 3 children, worked and ultimately retired. During college, my right arm was re-broken; an unsuccessful surgery followed which rendered it even less functional. A few years later, in an effort to reduce the pain and regain some motion, I had another surgery which also proved unsuccessful. Years later I was in an auto accident and the arm and elbow were damaged again. In addition, as I got older, the bones became brittle and arthritic and I suffered a number of fractures. Collectively, all of those incidents made worse, the pain, limitations and weakness in the arm.

I am sixty-four at the writing of this article, For the past sixty years I lived with a painful, 'bent' arm, always held somewhere at a stiff' 90 to 120 degree angle. I frequently cradled my right arm with my left, to relieve the pain. For that reason, I spent a lot of time in my life, standing, walking and sitting 'with my arms folded.'

The condition of my arm, through all those years, affected my appetite and often made it difficult or impossible to sleep. It sometimes interrupted my efforts to concentrate, sometimes made it difficult to carry and care for my children when they were small, caused a lifetime self-conscious sense about myself and frequently limited what I was able to do physically (i.e. to swim, play tennis, ride a bike and drive a car with one straight arm and one bent arm, etc.).  In addition, poor blood circulation caused my right arm and hand to always feel somewhere between 'a bit cool' to 'extremely cold.' Rarely was it at a warm, normal, comfortable temperature. As I got older, I could no longer turn a key in the ignition of my car, turn door knobs to open and close doors, or lift anything over a few pounds.

Fast-forward to February 2008. At the age of 64, I spoke with Dr. Douglas Hanel, Orthopedic Surgeon of the Arm and Hand Clinic at Harborview Hospital, Seattle, Washington. He examined my arm and x-rays of the same and then talked with me at length. I asked a series of questions. I also expressed a degree of fear and distrust of arm surgery, based on my history of three unsuccessful surgeries.

Dr. Hanel told me, with considerable confidence, that total elbow replacement surgery had the potential to reduce the pain and allow for better use of the arm. He asked me to spend the following month thinking about what we had discussed and then return for a second consultation.

During that month, I went to medical libraries, surfed the web for information on total elbow replacement surgery, a surgery far less common than hip and knee replacement surgeries. The information I found was limited, but informative nonetheless. I also located and spoke in person with a few people who had had the surgery.  Some were pleased with their outcome; some were not.   I also checked websites for patient and peer reviews of doctors, most specifically those pertaining to Dr. Douglas Hanel. Everything I found on him, without exception, bode extremely well in his favor.

 During my second consultation, we scheduled surgery for March 28 2008. I did not get a second opinion because I had talked with orthopedic surgeons off and on for years. And, with the exception of those who performed unsuccessful surgeries, I was told that my arm was so brittle, so badly damaged, the bones so badly fused, that there was nothing they could do for me.

Dr. Hanel was the first doctor I spoke with who had a track record with total elbow replacement surgeries. He explained, with candor, the potential benefits and risks, the length of surgery, the length of recovery and told me what I could, and could not expect of my hand and arm, subsequent to surgery. He convinced me beyond a doubt, that that he had the skills, knowledge and experience needed to perform a successful surgery. His overall confidence and anticipation of a good outcome were contagious.

On March 28, 2008 I headed for the hospital, eager to undergo the procedure. I was confident that the surgery would go well, the results would be good and that the recovery would go nicely.  I headed to the hospital believing that I would be living the rest of my life with a much improved arm.  Ultimately, all of those proved to be the case.

The surgery was completed. At some point after I gained consciousness, I was laying flat, looking to the left at a nurse who was entering the room. At that moment, I was using my left hand to massage my right hand.  The nurse looked at me and said, “What are you doing?” I said, “I'm massaging my right hand. It hurts. It's tingling.”

She smiled and said, “Look at your hands.” When I did, I was astounded to see that my left hand was massaging exactly where my right hand had been for the past sixty years – in the place at the end of an arm that had been bent at a 90 – 120 degree angle for the same number of years. I could 'feel' my hand in that spot, and all the tingling sensations and discomfort that went with it. I could even feel the texture of my skin and the bony structure of my hand and fingers. But, my hand was not there.

I was amazed to see instead, that my hand was at the end of my right arm which was held perfectly straight at my side by a splint. My 'real' hand was not even near where I had been massaging. I was even more stunned to realize that I felt absolutely nothing in my 'real' hand yet continued to feel pain and tingling in the place where my hand used to be. For the first time since I was four years of age, my arm was extended straight out. I was elated.

I had read about phantom pain, the phenomenon of feeling pain and other sensations in places where hands, arms and legs 'used to be' but were no more. “Wow,” I thought, “I am having what is likely to be a once-in-a-lifetime experience with phantom pain.”  One definition of the word ‘phantom’ is:  something (as a specter) apparent to sense but with no substantial existence. That defines my experience exactly. I was massaging the ‘specter’ of a hand – that, in fact, did not exist.

My Recovery: Thankfully, my surgery was absent all complications. After a six-day stay in the hospital I was released with instructions to do gentle flexing exercises at home. My first month was difficult but made easier due to the 24-hour-comfort-and-care provided primarily by my daughter Julie and my sister Leanna. And, at other points in time, by my son David, my sister Judith, my brother Richard and my nephews Mark, Andy and Evan.

I could do very little during the first few weeks at home. In addition to having no use of my arm held straight in a rigid splint, I had 24-hour nausea, dizziness, lack of appetite, headaches, mental confusion, overall weakness and other adverse symptoms. I was not able to do what the in-home physical and occupational therapists were asking me to do because I was too dizzy to stand and unable to take even two steps on my own, without falling.

For the first couple weeks, I required help with everything: sitting up, lying down, going to the restroom, changing clothes, getting in and out of a wheelchair, taking a sip of water, taking a bite of food, taking medications, taking two steps, using a walker, grooming, bathing, moving pillows and bedding to be more comfortable, brushing my teeth and every other simple task.

After a few weeks at home, all the while extremely ill, I came to the realization that my most debilitating problems (vertigo, headaches, nausea, weight loss, mental confusion, a sense of disorientation, etc.) were not caused by the anesthetic or surgical trauma as I had assumed - - but were caused by the pain medication. 

When that realization came, I stopped taking the medication cold turkey. Within two days every adverse symptom had disappeared with the exception of  the pain in my arm. Life was suddenly easier, more pleasant, more promising. Now, I had only one thing to contend with, the post-surgical pain.

Although the pain was rough at times, I much preferred it to suffering the foul, debilitating effects of the Morphine and Oxycodone.  Having shunned the medication, I was able to walk without assistance, eat with a normal appetite, think clearly, drink as much liquid as I needed, sit up, lie down, and eventually get into and out of the wheelchair – all without assistance.  Within a few more days I did not need the wheelchair anymore; I was feeling stronger, was no longer dizzy, and was steady on my feet.

Results of Surgery To Date:  Surgery was March 28 2008. This article was written June 10, 2008.

With the exception of rare 'pangs of pain' in my arm, I am living pain-free. I have normal extension of the arm. The rotation of my wrist has improved such that I can turn, with ease, door knobs, lids on some containers,  keys in locks and in the ignition of my vehicle. I had not been able to do those things easily for 60 years; I could do them with my 'old' arm but it required far more effort and caused far more pain than it does with my post-surgical arm.

While I can extend my arm straight out, I cannot yet bend it fully in the other direction. Dr. Hanel anticipates, however, that I will gain a wider range of motion with daily exercise and everyday use of the arm. At the time of this article, I am heading into the fourth month of a six-month period of recovery. I am elated with the improvements to date and will continue to do all that I can to gain even more use of the arm.

Daily tasks are easier and pain-free now: washing, folding and putting laundry away, ironing clothes, driving, shampooing, fixing things, brushing my teeth, washing my face, picking items off a grocery shelf and putting them in the cart, taking them out of the cart and placing them on the check-out counter, cleaning my dwelling, getting dressed. I can type faster and easier now. And, I use American Sign Language and I can 'sign' and 'fingerspell' more easily than I could with my 'old arm.'  Driving is much easier now.  And, I now do all of these, and many other things, pain-free for the first time in years.

I am in awe of my more usable, comfortable, more cooperative arm. The scar barely seems worth mentioning, it is of no consequence. I keep it covered for only two reasons: First, I don't like anything that draws attention to myself.  Second, I don't like responding to the frequent question, “What happened to your arm?” I answered that question often enough, during the sixty years before surgery.   

My new and improved arm comes with some lifetime limitations which are also of little consequence.  I was advised of the same, well in advance of surgery. The limitations are minimal matters when compared to the joy of living with a pain-free, more functional, fully extended arm.

I cannot use my right arm to lift anything heavier than 5 pounds.  I cannot put pressure on it such as to push or pull doors open or closed. I cannot use it to stop a heavy door that might come swinging toward my face, as happened the day I wrote this article. I cannot use it to open or close car doors, lift laundry baskets full of clothes, carry large bags of groceries, etc. Nor can I go bowling, play tennis or engage in many activities that have the potential to cause re-injury.  I regard those as small concessions when held in the light of all that I have gained and all that I can enjoy, for the rest of my life, with my 'new' arm.

I am currently training my less dominant left hand to do that which my right hand cannot or should not do. This is challenging. It requires my brain to convince my left hand to act as the more efficient, ‘in control,’ capable dominant hand. It requires my brain to convince my quick, adept, strong-willed right hand to do nothing, at times, and allow my left hand take over. In due time I am confident that both hands will be well-trained in this regard.

My right hand and arm continue to tire easily and both are weak, as has been the case for most of my life. I was told in advance that I would not gain additional strength in my hand or arm as a result of surgery. I was also told that both might tire easily in the early stages of recovery. As I continue a daily regimen of exercises, including the use of 3-pound weights, and as I use the hand and arm for daily activity, I am confident I will gain additional strength, motion and endurance in due time.

In spite of these limitations I just finished painting a living room using my right hand and arm, with only a little help from the left.  I had to take a few breaks now and then, to give the arm a rest, and then I would continue painting again.  I did not allow a single drop of paint to land on the wood trim, the carpeting or furniture - - a testimony to the incredible success I am having with my improved arm, thanks to Dr. Hanel and his colleagues. I will spend forever feeling  grateful  for their surgical skills, which will, no doubt, enrich every day  of the rest of my life.

For more information relative to my experience, you may email me: lynjwiley@quidnunc.net or post a message on this website if you prefer.

This is a new site, owned and managed by my daughter Julie A. Phillips. We welcome all posts that have anything to do with difficulty using one or both hands, wrists, arms, elbows, shoulders.  This site gives us a chance to share experiences, offer tips and information on assistive devices, ask questions of each other - and more.

We are eager to receive your comments and articles posted on this site.   

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