Osseointegration

Osseointegration: Groundbreaking surgery performed for the first time in SA

The future is here. Osseointegration is a revolutionary new treatment for amputees, and it made its South African debut earlier this month.

Osseointegration

Last week, South Africa played host to a pioneering treatment in the rehabilitation of limb amputees, called Osseointegratio – and it’s something that can dramatically transform the quality of life of amputees.

We know, you’ve got questions…

What is Osseointegration?

It’s a procedure designed to help amputees, and give them an alternative to traditional prosthetic sockets. Osseointegration allows for the direct skeletal attachment of external prosthetic components and ensures that a prosthetic limb effectively becomes socketless.

Osseointegration is the term given to when bone grows into the surface of a metal implant. The implant therefore unites with the bone and becomes a very strong and secure means of attachment of external prosthetic components.

How it works

The skin and soft tissue of the amputated limb is surgically opened and the remaining bone is hollowed out to allow for the placement of the osseointegration implant into the bone. The muscles are also reattached to enable them to function as anatomically intended.

The skin is closed and a metal abutment is passed from the implant through the skin to the outside. This metal abutment is highly polished and coated with a very specialised metal coating. This forms a mechanical attachment point for the external prosthetic limb components.

Over a period of weeks, the skin heals neatly around the metal abutment. The amputee quickly and easily connects and disconnect the external prosthetic components.

Who is Munjed Al Muderis?

Associate Professor Munjed Al Muderis, an Iraqi-Australian Surgeon, has played a tremendous role in advancing the progression and availability of this procedure to amputees everywhere.

His work on implant design, surgical technique and post-operative protocol has played a significant role in why reliable and reproducible outcomes in Osseointegration surgery is becoming an alternative to amputees all over the world.

His selfless dedication to train and equip surgical teams in various countries is further helping this cause tremendously. Once one of the most elite surgeons in Baghdad, Al Muderis was forced to flee the country for defying the orders of Sadaam Hussein: The dictator wanted him to surgically remove the ears of his opponents.

Al Muderis rebuilt his life Down Under, after a tumultuous journey from the Middle East. With him, he brought an exceptional set of skills. He specialised in amputations and used an illustrious career’s-worth of knowledge to develop a truly life-changing procedure.

Meet the team

Professor Nando Ferreira is the head of the Clinical Unit of Tumour, Sepsis and Limb Reconstruction at Stellenbosch University.

He recently underwent training in Australia for this operation and, to date, is the only surgeon in South Africa certified to perform this particular surgery using the Osseointegration Group of Australia implant and surgical technique developed by Associate Professor Al Muderis and his associates.

He was ably assisted by Orthopaedic Surgeon, Dr Gerhard Pienaar, of MediClinic Stellenbosch, and Dr Al Muderis arrived from Australia in order to provide his wealth of knowledge and experience to supervise the surgery.

First osseointegration in South Africa

This procedure was carried out at Mediclinic Stellenbosch, under the auspices of the Division of Orthopaedics at Stellenbosch University. The patient is a 28-year-old medical doctor, who is currently training to become an anaesthetist. Her journey to this point was a harrowing one, however.

The Cape Town local was severely injured after being hit by a car in her first year of university. She has been an amputee for more than 10 years but it hasn’t stopped her from completing her studies and performing her duties as a medical doctor.

The nature of her occupational duties, however, means she’s on her feet for extended periods of time, resulting in her often experiencing pain and discomfort of her residual limb at the end of a long day. This was limiting her working capacity and her quality of life.

Benefits of osseointegration

We spoke to Eugene Rossouw, the prosthetist present alongside Ferreira, Pienaar and Al Muderis during the operation in Stellenbosch. During our chat, he explained why this pioneering course of action could soon be favoured to more traditional amputee-care:

There is no socket, therefore all the typical socket related issues are eliminated, the most common being:

  • The elimination of skin irritation as a result of friction.
  • Elimination of sweating and heat rashes within the impermeable silicone liners.
  • The elimination of dissatisfaction of socket fit due to stump volume changes.
  • And, an elimination of discomfort in the socket while sitting.

There are also the following advantages of osseointegration vs traditional sockets:

  • It is much easier and faster to put the prosthesis on and take it off.
  • A much better range of movement as there is no socket to impede movement.
  • Amputees have improved proprioception (knowing where the limb is in space), allowing them to walk with more confidence.

Rossouw states that all of the above enables the amputee to wear a prosthesis for much longer periods of time
and walk longer distances with significantly more comfort, thereby improving what an amputee can do.

“This procedure is going to set the tone. In the next ten years, I believe osseointegration will become a well-accepted procedure available to many more amputees in South Africa.”

“We have to build confidence with this treatment, and that is now increasing and improving. It’s been around a long time but never gained momentum. There’s a conservative approach with osseointegration so we need to progress gradually.”

What osseointegration costs

The treatment does offer numerous advantages; however, it also comes at a price. Rossouw confirmed that Monday’s surgery cost in excess of just over R500 000.

He explained that this very specialised implant is made in very low quantities at this stage as compared to other surgical implants such as hip and knee joints which are made in the hundreds of thousands every year.

Indeed, half a million seems steep but in the long term, osseointegration actually works out much cheaper for amputees in the long term as it eliminates the need for socket replacements and the associated accessories such as silicone liners.

Of course, further consultations and a need to replace external prosthetic components means that an amputee
will never be completely free of prosthetic care and costs.

So, there we have it. Osseointegration is a giant leap forward in how amputees receive treatment and South Africa is joining a very small group of countries in the world that offer this treatment.

Osseointegration is nothing short of a medical marvel and thanks to Dr Munjed Al Muderis, these skills are being used for the benefit of many amputees, rather than for an elect few.

  • This article has been amended in consultation with Medical Prosthetist Eugene Rossouw, to more accurately reflect the intricacies of osseointegration and to correct some mistakes in the previous post.