An exciting new procedure that can drastically improve the lives of leg amputees was recently performed for the first time in South Africa.
A Stellenbosch University (SU) professor, collaborating with the Institute for Orthopaedics and Rheumatology (IOR) at Mediclinic Winelands, the prosthetist Eugene Rossouw, and Associate Professor Munjed al Muderis of the Osseointegration Group of Australia, performed South Africa's first osseointegration prosthesis implant on 5 November 2018.
The procedure was originally developed in Australia by Al Muderis, and involves the surgical implantation of the Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL).
“The OGAP-OPL is a revolutionary new type of prosthesis that does away with traditional suction sockets by directly attaching an amputee's prosthetic limb to the skeleton. This affords amputees some unique advantages and can drastically transform their quality of life," says Prof Nando Ferreira from SU's Division of Orthopaedics in the Faculty of Medicine and Health Sciences (FMHS), who was the lead surgeon on the procedure.
Amputees frequently suffer problems with traditional suction sockets, such as skin irritation, poor fit due to sweating and volume changes of the stump throughout the day, discomfort while sitting, and the time it takes to attach and remove a prosthesis.
These socket-related problems are eliminated with an osseointegration prosthesis because the prosthetic limb is directly attached to the skeleton. Recipients also have better proprioception (perception of the body's position and movement) and can feel the surface they are walking on, allowing them to walk with more confidence.
The osseointegration prosthesis also restores the normal anatomical alignment of the thighbone (femur) (see image insert), which significantly reduces common gait deviations in above-knee amputees.
However, the procedure is not without complications. Infection around the implant and fractures of the remaining bone are the most significant complications following osseointegration. “Candidates are carefully screened for suitability and currently only individuals suffering severe socket problems that significantly interfere with work and daily life, are considered for this procedure," says Ferreira.
The recipient of South Africa's first osseointegration prosthesis implant is a 28 year old woman who suffered a traumatic above knee amputation in 2009. Since then she has struggled with her socket prosthesis, which severely interferes with her occupation and activities of daily life. (The patient has chosen to remain anonymous.)
“The unique design, materials and manufacturing process of the OGAP-OPL allows bone to grow into the surface of the implant and therefore 'integration' of the prosthesis into the skeleton. A specifically designed abutment then passes through a surgically created opening in the leg stump to create an attachment point for the external prosthetic limb components," explains Ferreira.
Al Muderis is the Australian surgeon who pioneered osseointegration and developed the OGAP-OPL prosthesis, the surgical technique, and the rehabilitation protocol over the last decade. To date, approximately 750 surgeries have been performed, mostly in Australia.
“Professor Al Muderis' enthusiasm for changing the lives of amputees is evident in this tireless work and willingness to train other surgeons in his technique," says Ferreira, who travelled to Sydney, Australia, along with husband and wife team, Eugene (prosthetist) and Fransien (physiotherapist) Rossouw, to undergo training in the surgical procedure, prosthetic fitment and rehabilitation directly from Al Muderis. This team is currently the only group certified to use the OGAP-OPL prosthesis in South Africa.
For the surgery, Ferreira was assisted by Dr Gerhard Pienaar, an orthopaedic surgeon from IOR and Mediclinic Winelands, and Al Muderis, who travelled from Australia to assist with, and supervise the surgery. The patient is progressing well, and her first prosthesis fitment was done two weeks after the surgery. She has commenced with a 12 weeks rehabilitation protocol that involves progressive weight bearing while using two crutches for six weeks, followed by another six weeks of assisted mobilisation using one crutch.
The team plans to offer the procedure to more patients, both in the public and private health sectors, and hopes to see it become a well-accepted option for amputees in South Africa.