Improvements in manufacturing processes and capabilities allow for more complex and diverse solutions to be thought up for an increasing number of problems. The ability to cut and machine smaller and more complex parts using modern techniques like waterjet cutting, 3D printing and various multi axis machines, combined with software developments mean this is becoming increasingly evident in the medical and pharmaceutical world. The ability to make one off, custom implants and limb replacements for specific patient needs is opening up a whole new world.

One of these areas is osseointegration – the use of titanium pins that are implanted directly into the bone. Earlier this year we wrote about the work of Dr Max Ortiz Catalan who, along with a university and hospital in Sweden had perfected the technique of osseointegration (the OPRA implant system) and had been piloting implants since 2013. However, this operation was different. This patient was only one of 2 in the world to have a series of electrodes connected to the muscles to give stable and precise control. So successful was that surgery that the patent returned to his occupation as an operator of heavy machinery.

Despite the success of osseointegration surgery overseas, with over 400 having successfully received the procedure, expansion of the use of the procedure appears to be slow.

What are osseointegration and the OPRA System?

This is the area of prosthetics where an implant is placed into the bone and becomes a permanent part of the body. The artificial limb can then be permanently attached and has more freedom of movement – no more loose or poor fitting prosthetics and no more rubbing, chafing or soreness so commonly associated with new prosthetics. Many users abandon the use of their prosthetic limb within 2 years because of this type of problem.

The implant is made from titanium as this can integrate with bone and the procedure is done in two parts. A cylinder shaped fixture is implanted in to the central canal of the bone. After a number of months, and once that implant has become securely attached to the bone an abutment is attached that will hold the external prosthesis.

In May this year the first procedure in the United States went ahead on a patient who had lost his leg below the knee as the result of a tumour.

In December last year the Ministry of Defence announced that they would be investing £2m into a pilot to use osseointegration for serving personnel and veterans who have lost their limbs and are experiencing problems with their existing prosthetics. The procedures in the UK will be carried out at Queen Elizabeth Hospital Birmingham (QEHB) by Sydney based Dr Munjed Al Muderis. He is an expert in the technique and has already completed more than 180 operations.

Dr Al Muderis fled Iraq in 1999, after refusing to mutilate Iraqi army deserters. He started a new life in Australia and trained as an orthopaedic surgeon and is now chairman of the Osseointegration Group of Australia.

NHS England will be keeping a close eye on the trial. It is hoped that if successful, this trial will pave the way for the procedure to be rolled out and transform the lives of other amputees across the country.

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