Photo: Christopher Rowles | Cedars-Sinai
A new kind of prosthetic leg that fuses with bone has helped change one man’s life and could become the future for amputees.
Christopher Rowles is one of the first people in the U.S. to trade in his traditional prosthetic leg for a semipermanent option, thanks to a procedure known as osseointegration.
Rowles, a 59-year-old retired Los Angeles Police Department officer, had his left leg amputated after a staph infection in 2011.
But his traditional prosthetic leg that attached with a socket left him unable to comfortably walk or drive, let alone river fish — a longtime hobby of his.
There were times when the prosthetic even would detach from his body and fall behind him as he walked.
“I would keep walking and all of a sudden my leg would be a few feet behind me and I’d fall to the ground,” he told Healthline.
He says the process of removing and changing the sheath that attached his prosthesis to his knee was also onerous and inconvenient.
“I used to always call it my giant condom, because you had to roll it on to your stump,” Rowles said.
Not only was Rowles barely using his socket prosthetic, the old prosthetic was increasing his risk of further injury.
Dr. Daniel Christopher Allison, a surgeon at Cedars-Sinai Medical Center in Los Angeles, treated Rowles and said the former police officer was an ideal candidate for a procedure called osseointegration. The procedure involves putting a permanent implant into bone, which can then be firmly affixed to a prosthesis.
In December 2016, they began the two-part procedure, which is somewhat similar to getting a dental implant.
In the first surgery, a metal stem is put in at the knee and left to fuse with the bone. In the second procedure, months later, the prosthetic is attached to the part of the anchor that sticks out of the leg.
After that, with some help from physical therapy, Rowles said, things changed.
“Everything’s different. I go to the gym five days a week, I can do things I wasn’t secure with,” Rowles said. “Even driving’s easier, even though it is my left leg that is amputated.”
And, he says, the new implant takes him just 30 seconds to take on and off.
“I walk straighter, much more upright, I’m not leaning or doing anything in my gait,” he said. “My body feels better.”
A different kind of prosthetic
The basic idea of osseointegration for prosthetic limbs has been in development since the early 1990s in Sweden, where the method was adapted from dentistry.
Allison said that after its introduction in Europe, the procedure also gained popularity in Australia.
But in the United States, the procedure remains extremely rare. The first U.S. patient to have an osseointegrated prosthetic underwent surgery in San Francisco in 2016.
The version of the procedure Allison performed on Rowles is also not yet fully approved by the U.S. Food and Drug Administration, although it is allowed on an individual case-by-case basis.
Allison is hoping to get humanitarian approval from the FDA in the future, which would allow the procedure to be performed on the relatively small population of amputees interested in this option in the U.S.
While there are benefits to having a more stable prosthesis, there are also potential drawbacks for patients, including higher costs and health risks after surgery.
In Sweden, a robust public healthcare system keeps the procedure relatively cheap, according to Dr. Örjan Berlin, an orthopedic surgeon who has worked on osseointegration at the University of Gothenburg in Sweden.
But in the U.S., even traditional prosthetics can cost thousands of dollars, much less osseointegrated prostheses that require a surgically-placed implant.
In Las Vegas, one patient had to raise $18,000 through crowdfunding to pay for an osseointegration surgery, according to the Las Vegas Review Journal.
“This is still new and it’s not without complications, and we can always make things better,” Allison said of the cost.
In Rowles’ case, his medical bills were covered in full by his workers’ compensation program.
In addition to higher costs, the procedure is not without its risks. The biggest health risk is the potential for an infection at the site where the prosthetic meets body tissue.
In Sweden, Berlin said, infections are common among patients undergoing the Swedish method of the procedure, but they are usually cured by antibiotic treatment.
In addition, overall infection rates have gone down since the procedure was first introduced, Allison explained, and not all infections require treatment.
The process of getting fitted for a prosthetic can also be lengthy. Rowles had to undergo an MRI scan of his leg, which was sent to Australia where parts for his prosthetic were custom made.
Going bionic for the future?
Despite the cost and extra steps, Rowles is happy to have upgraded his leg and enjoys his increased mobility.
In the future, Allison says he hopes to be able to perform the procedure for people with amputations above the elbow.
Potentially these permanent implants could go fully bionic, according to Allison. He explained these kinds of prosthetics can be made myoelectric or neuroelectric, allowing patients to control their prostheses with the electric signals generated by the muscles or the brain.