An Innovative Surgical Procedure Improves the Prosthesis Experience

X-ray image of the metal rod that is implanted into a patient’s bone during the osseointegration procedure

On Sept. 7, 2017, Curtis Kindred, Jr., was involved in a traumatic industrial crane accident at work. Known as a “rigger,” Kindred helped assemble large cranes for heavy lifts on construction sites. That day, a 20,000-pound crane block fell on him, crushing his right arm and hand and completely severing his left leg above the knee. Within minutes, Kindred, who had previously worked as a nurse for 22 years and still carries a valid nursing license, placed a tourniquet on himself before Memorial Hermann Life Flight® arrived on the scene. By the time the helicopter landed at the Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center, it was clear his quick thinking and past training had saved his own life.

“I remember one of the Life Flight nurses came to visit me in my room and they told me to make sure I thanked whoever put my tourniquet on. I raised my hand and said, ‘Trust me, I do,’” Kindred said. “I really believe that’s why I never lost consciousness after the accident happened.”

Not long after, Kindred learned about a new type of advanced prosthesis for people who have transfemoral, or above-the-knee, amputations that was said to be more user friendly, comfortable, and allowed for enhanced mobility. Originally pioneered in the early 1990s in Sweden, the technique and implant has been widely used in Europe and Australia, but at the time of Kindred’s accident, it was still going through the approval process by the U.S. Food and Drug Administration (FDA) and not yet available to patients in the U.S.

“For the time being, I was fitted with a standard socket prosthesis and learned to walk on that,” Kindred said. “Then in December 2020, the FDA approval went through.”

Named the Osseonachored Prostheses for Rehabilitation of Amputees Implant System, and known throughout the field as osseointegration (OI), as the name implies, the patient’s bone grows into the metal rod, integrating with the implant and creating a long-lasting and seamless connection between the body and the prosthesis. The technique requires two surgeries performed approximately three months apart. During the first procedure, the patient’s bone is prepared and implanted with the device, along with bone grafting. Between that procedure and the next, the body’s natural healing response sets the rod into the bone, forming a solid and durable biological bond. During the second procedure, surgeons extend the rod outside the bone through a delicate plastic surgery-created opening that allows the skin and bone to grow into one another and anchors the amputated muscles to the bone for improved balance and control. Once healed, the patient can directly attach and remove their prosthetic limb in seconds, and with training and physical therapy, can regain their function and independence.

“Osseointegration is designed for people who experience rehabilitation problems with conventional socket prostheses and who would benefit from the kind of advanced mobility this system offers,” explained Dr. David Doherty, Jr., assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston and an orthopedic surgeon affiliated with Memorial Hermann.

In February 2021, Doherty and his surgical team performed the first procedure on Kindred at Memorial Hermann Orthopedic & Spine Hospital. Three months later, they completed the second surgery. Today, Kindred is amazed at his improved experience with his new prosthesis system.

“After having my leg in a socket prosthesis for four and a half years, I can tell you the sensation I now have when walking is completely different,” Kindred said. “When I was wearing the socket, I was dealing with a lot of daily pain and discomfort, and now there is little to no pain at the connection site. It is also so much easier to get the prosthesis on and off—before, it would take so much time to get ready in the morning and now it just clicks in and out, and I can get ready in under two minutes.”

Patients who have had osseointegration frequently refer to the difference in sensation they feel, noting that walking feels more natural and, with time, they develop a sense of the surface underneath. Studies have also demonstrated significant improvements in regards to pain, function and confidence.

“Because the prosthesis is attached directly to the bone, patients with OI experience a phenomenon known as osseoperception, where vibrations of walking resonate through their skeletal system allowing them to differentiate types of surfaces on which they walk,” Doherty explained. “OI allows for a more natural walking pattern at a faster pace with more confidence, as well as the ability to wear their prosthesis longer. Our patients say OI is life-changing, significantly improving their quality of life as an amputee.”

Kindred himself is back to work, still at construction sites but now, in a permanent position as a safety coordinator at JSW Steel USA—working hard to ensure that accidents like his are avoided. To date, Memorial Hermann has completed 10 osseointegration procedures, with plans for offering this revolutionary system to countless more patients to help improve their daily life and mobility. Although other programs in the country are forming, the program in Houston is unique in that the surgical team works closely with TIRR Memorial Hermann to offer a comprehensive center for both the surgery and rehabilitation components. Notably, TIRR Memorial Hermann was recently ranked No. 2 among the country’s top rehabilitation hospitals in the U.S. News & World Report’s Best Hospital rankings for 2021-2022.

“This system is truly changing the landscape for patients who have limited ability with their socket prosthesis,” Doherty said. “As a surgeon caring for people with limb loss, we are thrilled to finally be able to offer this procedure to our patients.”

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Ali Vise