Being a curious person, I have google search-alerts active to keep me informed of developments in the world of osseointegration. It was with some interest then that I clicked on the link below found in one such alert to see what was going on in America. Reading the article to the end I even came across my name seemingly endorsing this approval.
Whilst I do believe that all amputees who wish to benefit should have access to implant technology, and America is lagging behind most of the developed world in osseo adoption, I’m not sure OPRA is the system that should have received FDA approval first.
Back out in the hills for the first time in a long while and I had the pleasure of four other amputees for company! Two old friends, two new friends and myself gathered for a walk in the countryside to help with their training for a stroll up Mount Snowdon organised by Limbpower – everyone’s favourite amputee sporting charity!
Crossing the river Mole the ordinary way…
We set off from the top of Box Hill and immediately dropped down the steepest track to the river Mole where first a footbridge then a more exciting set of stepping stones allowed us to cross over and return.
Crossing back using a slightly unusual method!
Video of our crossing…
A second circuit to the north-east of the visitors centre meant that our total distance was around 8km with height gained and lost of 310 m (over 1000 ft!).
A well satisfied group at the end
GPS tracking data showed the routes of our two circuits and the elevation profiles – pretty impressive for a gentle training walk!
Perhaps in anticipation of the Guardian article being published, Stanmore Implants have updated their ITAP webpage giving a good deal more information than was previously available. Click on the thumbnail below to check out the real thing!
Yesterday evening I was alerted via Facebook that the following article had appeared on the Guardian Website:
Sadly I have found that publicity regarding any of the various osseointegration techniques tends to be fairly divisive amongst fellow amputees. Admittedly ITAP and similar implants are still currently available to only a small proportion of the amputee population that may benefit, but osseointegration is still a novel and somewhat experimental methodology which only by embracing will make more widely available. My response to the qualified welcome that the article received was as follows:
“ITAP has been nothing short of a personal revolution, allowing me to experience a level of functionality that I never thought would be possible of an above-knee amputee using a prosthesis. I agreed to be interviewed in order to present a patient’s perspective of what my personal experience has led me to believe is a significant improvement in prosthetic technology. As a participant within the trial, I have only a limited understanding of the eligibility criteria that currently define who may benefit from ITAP, but I do believe that presently these are quite narrow. I do know that all of my fellow trial participants that I have met at hospital visits have experienced similar improvements in quality of life to myself. What I would like to hope for in the near future is that as experience with implant technology increases, the group of amputees that may benefit in a similar way to myself will expand to encompass the majority of those that would opt for a surgical option to improve their mobility. This evolution in technological application has recently been demonstrated in Australia where a below knee amputee has been a recipient of similar technology and was walking eight weeks post-op (more info can be found here: www.amputeeimplantdevices.com). I agree that the optimism with which this article should be greeted must be guarded, however, I do believe optimism that there is future hope for improved quality of life must surely be a good thing!”
One of the first questions I am often asked when fellow amputees and ‘normal’ people find out about ITAP is: ‘Can you run with that?’. As with most things in life, the answer is not a simple one!
Everyday movements impart various forces through the body that are borne by the skeleton. Obviously, for an implant attached prosthetic leg, ground impact and other forces will be conducted by the prosthetic into the skeleton via the implant/bone interface. Considerable effort and ingenuity is therefore expended by the designers of implants to ensure that their devices maximise the process of integrating themselves within the residual bone in the stump after surgical implantation (known as osseointegration). If the osseointegration reaches a suitably high quality then the implant should be sufficiently strongly attached to the bone to withstand the various forces encountered in everyday life. It is now thought that the process of osseointegration can be stimulated soon after surgery by gradually loading the implant with initially small but appropriately increasing forces during the course of the recipients rehab. This is exactly what I experienced in the months after my surgery, guided by the excellent physiotherapist that supervised my recovery. As I understand it, small forces initially stimulate the microscopic inclusion of bone into the adjacent surface of the implant, giving a ‘tight fit’, which continues into significant bone remodelling as the rehab forces increase, resulting in stronger overall bone to support the entire structure of the implant.
In order to protect their ‘investment’ in myself as a trial patient, I was advised by the ITAP designers that I should refrain from any high impact activities after my implantation. The forces experienced by a lower limb whilst running are likely to be considerably larger and at a higher rate of repetition than anything that would be generally experienced on a day to day basis and would definitely be considered high impact . For an implant to withstand these forces, the quality of integration between bone and implant would need to be proportionally higher than otherwise required and this would need to be combined with with additional overall bone strength. Some years ago now, I had a very gentle attempt at running and fortunately suffered no ill effects. As a result of this experience I speculated that it may be possible to run safely with an implant and the appropriate prosthetics, assuming the inherent springiness of a blade would provide some level of cushioning from the impact forces, and after gradually building up the intensity of exercise to allow the bone within the stump to cope with the forces involved via the process of remodelling.
After that significant preamble, I have finally come to the point of my post. Whilst trolling through my computer files recently I found a photograph I had taken some time ago of one of my follow up x-rays (three years post-op I think). The thickness of the bone where the implant emerges looked pretty impressive to me so I dug out a post-op x-ray for comparison (left = post-op, right = three years later).
Looking at the two images, the differences that three years of weight bearing use have wrought upon what remains of my femur are clear to behold. All the cycling, mountains and long walks appear to have had an effect – demonstrable evidence of the effect of bone remodelling.
Back to the question at hand; is it sensible to run with an implant? There’s still no definitive answer but I’d happily have another go, especially with appropriate prosthetics, now I’ve seen how my implant is embedded in the bone!
Reflection and introspection have never been strong points of mine but I regularly read other people contemplating the hand that fate has dealt them on the day of their ‘ampuversary’ so I thought I would similarly indulge myself.
I fairly regularly read people stating that losing a limb was the best thing that ever happened to them. Except in certain circumstances, such as chronic, degenerative conditions, I marvel at what I can only assume is self-delusion in an attempt to reconcile themselves to their current situation. If I could have my current life as it is but with two legs then I would obviously exercise that option. I would have preferred to have avoided my accident on that fateful day and have no doubt that had I done so my life would differ in many ways. Ultimately, a moment of carelessness which I deeply regret led to me losing my leg and it is something that I have had to learn to live with.
Twenty-one years ago today I was beginning the process of recovery by speculating about the various changes that losing a leg would impose upon me. I don’t think the full realisation that I was now an amputee had begun to manifest itself. I’d never met an amputee before and had no idea of the limitations or possibilities that prosthetic use would impose or allow. During the course of my rehab I fairly rapidly realised that the main factor limiting the mobility of an amputee using prosthetics was the socket but there appeared to be no alternative. Fifteen years later, having largely accepted my fate, I was given the chance of such an alternative and fortunately made the decision to go ahead. As a result of ITAP, I no longer consider myself a ‘normal’ amputee as I’m not constrained to walk within the envelope of soreness and acceptable pain that blights the lives of many, if not most, amputees. The increased level of mobility I now enjoy largely mitigates the point of an ampuversary so I perhaps I ought to only celebrate the anniversary of my ITAP surgery, although I’m struggling to think of a catchy phrase for this day! All the while my implant performs as intended, I will try and make the most of having essentially been given my leg back and hope that more amputees can benefit from ITAP technology in the future.
Although not a viewer of breakfast TV, Henry’s requirements obviously take precedence, I was slightly surprised but pleased to see on the BBC website that ITAP had made it on to their breakfast programme:
The patient did a pretty good job of explaining the benefits of implant technology without explicitly naming ITAP but the failafe he has is pretty distinctive and very familiar! I do wonder where the statistics he states for numbers of recipients originates as I thought there were more patients than nine. I also think it is a slight shame that he mentioned his infection. Whenever any osseo procedure is discussed there is always alot of scaremongering regarding infection. Infections are (so far!) not enevitable with an implant and ITAP was specifically designed to minimise this risk and continues to be developed. I’m fairly sure that all recipients of any of the implant systems available would state that the small risk of infection is worth the vast improvement in function associated with getting rid of the socket!
It’s been a pretty barren winter for me from a walking perspective – my crampons are likely to remain unused. I’ve had various day walks planned but for various personal reasons have had to pull out. Fortunately Scouting has come to the rescue!
The first week of Febraury saw my Troop and I wandering around the Surrey countryside looking for Geocaches as part of our winter camp. Anyone that has looked outside recently may have noticed that the weather has been a little damp. This was certainly evidenced by the conditions we experienced underfoot. At one point on our route a river started to flow down the path and continued for at least half a mile!
Still fun to walk through…
Walking with the Scouts is another example of something I wouldn’t have comtemplated before ITAP (in fact, I doubt I would have offered my services as a leader at all before ITAP). My implant somewhat mitigates the requirement to concentrate on what I’m doing to avoid falling over, allowing me to keep sufficient a watch over what the Scouts are up to to feel that I am providing a measure of supervision!
Five years ago, at about this time, I was returning to the ward at the Royal National Orthopaedic Hospital in Stanmore in proud possession of a shiny new ITAP. Actually, on reflection, it wasn’t that shiny any more as it was covered in ooze! Fortunately for me the ooze dried up pretty quickly and within a few months, guided by careful application of physio-led exercise, I was back walking on my prosthetic in a manner that profoundly redefined my level of disability. For the vast majority of the activities of everyday life and beyond, my surgery five years ago effectively gave me my leg back. That may sound like an overstatement but it is hard not to feel so empowered when I can now do the things that I can do!
The highest point in Northern Africa!
However, when osseointegration techniques make one of their regular appearances on social media there seems to be a division of opinion in the discussion. Access to implant technology is often limited in a fashion that makes it controversial, the costs are not inconsiderable, these techniques have application to a limited number of amputees and there is a perception of limited functionality with an implant. All these factors restrict the enthusiasm of the majority of amputees when implants are discussed. I sincerely hope these barriers to large scale implant uptake are overcome as the slowly rising numbers of recipients spread the word on their newly rediscovered capabilities, thus allowing ITAP and similar technologies to benefit anyone that has the need for them without having to take a bold and potentially costly step into the unknown!
Some twenty years after I last had a go at abseiling I’m at it again! My Scouts on camp all got to take part in the activity and I didn’t want to miss out. I realised that as soon as I started to descend and took weight off my prosthetic that gravity would take over causing the leg to bend and not be useful. My rheo knee lacks a locking mechanism so I simply had to use one leg alone. It was quite an effective technique and I was looking good until I misjudged my landing and nearly ended up sat on the floor. Looks like I need more practice!