Tired of walking on clouds, woman can now feel the ground beneath her
The 28-year-old is the first South African to have her false legs attached directly to her skeleton
For the first time in 10 years a woman is able to feel the ground she is walking on.
The 28-year-old became the first South African to receive an osseointegration prosthesis implant on November 5 this year.
Five weeks into her recovery, she is raring to go. Doctor Nando Ferreira, head of the orthopaedic surgery division of the department of surgical sciences at Tygerberg Hospital, said his patient was healing so well that they have had to ask her to slow down a bit.
Ferreira was the head surgeon in the groundbreaking procedure which directly attached the woman’s prosthetic limb to her skeleton.
The procedure was developed in Australia and has to date helped more than 700 people achieve a more comfortable gait.
Ferreira said the procedure, which was first performed in 1995 in Australia, was similar to the procedure for tooth implants.
He said he first heard about the procedure in 2015 at a medical conference in Miami in the US where he heard Dr Munjed al Muderis of the Osseointegration Group of Australia speak about the implant.
Ferreira spoke to colleague and prosthetist Eugene Rossouw about the impact the implant could have on his patients and the two went to Australia in 2017 to learn the procedure.
“A lot of patients struggle with wearing prosthetic limbs; they are time-consuming to put on and for some they cause swelling and pain. Especially for above-the-knee amputees, the plastic sits right into the groin. It can be uncomfortable to sit on hard surfaces, amputees are unable to sit on low surfaces, and if they go to the bathroom in some cases they need to remove the prosthetic and then redress, which takes time.
“People also don’t realise that because a prosthetic is attached to soft tissue, the amputee cannot feel the ground, they don’t know by feel if the surface is hard or soft so there are issues in the dark; they don’t know what kind of pressure to apply to the ground; all kinds of things able-bodied individuals take for granted.
“People who wear prostheses also do not have as much control in terms of rotation of the leg so getting out of tight spaces, even in places like restaurants, is difficult. The implant changes that.”
Ferreira, Rossouw and Muderis performed the operation in SA on a woman who suffered at traumatic amputation 10 years ago. “She was the ideal patient because she was really struggling with her prosthesis; it caused her bruises, pain, swelling, and she was struggling at her job with sitting for long periods of time.
“This procedure will not be for everyone. It will be for the patients, like her, who cannot manage an ordinary prosthesis.”
Rossouw had been working with the woman to try and mitigate the problem, but to no avail.
Ferreira said the rehabilitation process was arduous. “The bone has not taken weight for years. We have to slowly introduce weight to the bone which has to be trained and has to regrow to its new function.”
The patient needs to use two crutches for the first six weeks, then spend another six weeks on just one crutch. But the doctors say they are happy with their patient’s progress.
“She is eager to do more than we allowed her to do. She wants to get up and going, so we have advised her to take it easy,” Ferreira said.
He said the biggest issue with the procedure was the cost – a patient is looking at between R400,000 and R500,000.
However, the doctor said that he is in talks with medical aids.
“We’ve costed that after eight years the implant will be more cost-effective than the upkeep of a prosthetic leg. So in the long run, for many patients, it is better to have this procedure.”
He said the implant was not risk-free. “There is a risk the bone could fracture. There could be infection, especially because the implant protrudes out of the skin.”
He said there were also oversights the team had not factored in when performing the operation.
“Because they [Australian doctors] had been performing the operation for such a long time, and because we did not know what to ask, there were things we did not factor in which we have since learnt – like next time we will probably involve a biokineticist and a physio.”
These doctors would start working with the patient before the operation to work on the muscles, which would help with gait.