My world changed after osseointegration by Glenn Bedwell

At the time of my accident, I was working and living in Cairns with my wife and two sons. My job required me to be physically mobile, so I spent my workdays walking around with lengthy periods on my feet. Following my amputation, my family and I moved to Sydney for a less physically demanding job and to undertake rehabilitation. Soon after arriving in Sydney, I was fitted with a comfortable silicon suction socket by my then prosthetist David Howells. Prosthetically, all was well for many years.

After two years in Sydney, I decided that I’d had enough of the traffic and the rat race and was keen to recommence my career in an operational position. To be honest, I had a need to be reunited with the place where I had lost my leg.

I returned to Cairns and to my previous role which required MBWA (Management By Walking Around). At the time, my socket was up to the task, even given the difficulty of living in a tropical environment and constantly walking on my prosthesis.

After 19 years of comfortably using a silicone liner, my skin suddenly became intolerant. No number of creams, lotions or different liners helped my situation.

It was around this time that I first heard of osseointegration (osseo or OI) and was excited by the prospect of not having socket issues or liner problems ever again. Osseointegration is the surgical implant of connecting rod into bone which comes through the skin to allow direct connection of a prosthesis. I decided to book a clinical appointment. I underwent x- rays and scans, completed the panel and individual interviews, and went through an evaluation process, prior to being accepted as a patient.

In the early days of osseointegration in Australia, most of the information available was regarding the surgical process and rehabilitation of the patient with little about the future day-to-day impact. Nor were there many previous patients to provide information about what changes to expect. For me, the major consideration to undergo osseointegration was based on the need to overcome my physical skin to socket issues.

My osseointegration journey physically commenced in July 2012, with my desired expectation and hopeful outcome to be able to wear a prosthesis for many hours without any skin irritation or discomfort. The outcome I achieved provided all this and so much more than I had either considered or wished for.

I had my first operation in July 2012 and was Prof Munjed Al Muderis’ 13th osseointegration patient. In those early days, the process of osseointegration was a two-stage surgery with an initial operation, a month’s rest and healing, then a second operation (incidentally, it’s since changed with most now completed in a single surgery). A few days after the second operation, I began weight bearing via the embedded adapter. After a further ten days I had my first prosthesis fitted, and then began standing using the support of parallel bars.

The first time standing with the implanted device is the first revelation of what osseointegration means and what it provides to the patient. I suddenly realised that my world had changed forever. For the first time since becoming an amputee, I could feel the ground under my amputated limb via my bone structure; I was taking my weight equally in both my left and right leg rather than having a vague feeling transmitted via a prosthetic socket.

I cannot emphasise the importance and usefulness of the feeling of the ground underneath you; something known as ‘proprioception’ - awareness of the position and movement of the body. When walking the sensation of direct transfer of information from the ground to my prosthesis to my bone structure, then to my brain, seems to mimic the feelings and sensations you receive from your sound leg. Without looking down you can feel different floor coverings, be it carpet, concrete or tiles etc. And most interestingly, you can actually sense where your foot is in space, something we call ‘osseo perception’.

Walking has become an enjoyable and a comfortable task. There are now no pressure points from a socket to cause pain, no rubbing, no chafing, and fluctuations in weight that cause stump volume changes are no longer a problem. My prosthesis always attaches with correct alignment and it can’t slip off due to sweat or loss of volume.

For both exercise and enjoyment, I now walk every day and do so in comfort for a minimum of 10 kms. Most days its nearly twice that distance. I would very rarely have been able to match that distance when using a socket suspended prosthesis.

The positives of osseointegration for me

Not having a socket also provided other additional benefits I had not initially considered:

• No pressure points
• Better control and available movement of my femur, that is I can rotate my femur to rotate my foot position if I wish
• Less back or shoulder pain issues, as walking with osseointegration gives me a normal gait rather than the swing or hip throw of the prosthesis with a socket attachment
• No wear and tear to my trousers caused by the socket rim
• Less volume in my trouser leg due to no socket
• I can comfortably sit on a bar stool or hard based chair
• I don’t break toilet seats anymore
• I can sit on a bicycle seat or any gym equipment seats
• Hot and humid climate doesn’t cause fit or sweating issues
• No ongoing socket updates are required
• When waking up in the middle of the night for a bathroom visit, it’s so easy, quick and safe to clip on my prosthesis rather than using crutches
• If I have to, for any reason, take my prosthesis off in public, I don’t need to remove my pants
• Less visits to my prosthetist due socket issues or to order additional socks etc.

We have family living on the east coast of America which means flying for a minimum of 12.5 hours on the first leg of the trip. I was never able to remove my socket during any flight because of stump swelling and risk not being able to fit the socket back on again upon landing. Instead, I had to contend with the discomfort of sitting during the entire flight feeling an uncomfortable tightness within my socket. But now there is no socket to cause discomfort and, as a bonus, I can also drop the prosthesis off the external fixture during flight to make sleeping in a chair more comfortable.

Another wonderful benefit is I can now use a shower leg. The foot is non-slip so I can now walk into and stand on two legs in the shower without needing crutches or a shower chair for safety. I also use the same leg in the swimming pool which makes climbing out via the stairs easy and safe, and it makes it safer when walking in the surrounding wet areas.

The negatives of osseointegration for me

The skin on your stump needs to be in pristine condition prior to osseointegration surgery, so I couldn’t wear my previous socket-based prosthesis for two weeks prior to surgery.

The osseointegration to prothesis attachment passes from my femur bone to an external attachment via a stoma. As the stoma is an open wound, there is always the risk of infection. Living in Cairns, the heat and high humidity is an ideal breeding ground for infection. I suffered skin infection around the stoma six times in the first year which required antibiotics each time. To prevent infection, I now use a natural antibacterial spray with oregano oil which has prevented infections ever since.

I have unintentionally cut the sheets, as well as my wife, in bed due to the sharp edges on the external fixture. To prevent this, I use a plastic cap that covers the sharp edge of the attachment.

Due to the connection of my prosthesis to bone, the offshoot of that amazing feedback from ground-to-foot-to-knee-to-bone means that any terminal impact from the knee on leg extension is very undesirable, uncomfortable, and immediately tiring. In my experience, this necessitates using a prosthesis with greater terminal impact control, which in my case means using a Microprocessor Controlled Knee which is quite suitable for osseointegration.

After nine years I have not had any other negative experiences in relation to osseointegration.

Osseointegration has certainly given me a lot of benefits, and I’m pleased to be able to share both my positive and negative experience with others. Like any surgery the decision to have osseointegration is something you should research, speak to others about and meet with the relevant medical specialists – that way your decision can be an informed one.