How a bionic bone implant could give arthritis the elbow
PATIENTS facing arm amputation due to severe arthritis caused by a non-healing fracture may have their limbs saved thanks to a revolutionary ‘bionic’ bone replacement.
The pioneering surgery involves replacing the broken and arthritic section of bone with a custom-made titanium alloy prosthesis which is articulated at the elbow end where it forms a hinge joint.
The first patient to have one fitted is 67-year-old Julie Martin, a retired careers adviser. She has spoken about how the operation ended 19 years of pain and disability that started when she broke her left elbow in a bicycle accident in 1998.
Previously unable to even lift a knife or fork or cup of tea, she has now regained use of her arm. She said: ‘It’s made such a huge difference to my life, because being in constant pain is so difficult. It’s incredible to think my arm is part me, part metal – I joke that I now have a bionic arm.’
Although similar prostheses have been implanted into bonecancer patients, this is the first time one has been used as a solution for arthritis brought on by a non-healing fracture.
About 850,000 Britons suffer a broken bone each year, and around half are in the arm. When an elbow is fractured, the cartilage – tissue lining the joint, allowing smooth movement – can be damaged and arthritis may develop with bone rubbing on bone.
EIGHTEEN months after her fall and after failing to heal, Julie had an elbow replacement. But infection set in, so more surgery was required. She had more than 20 operations, including elbow replacements and bone and skin grafts.
As each implant loosened, it damaged bone which dissolved and was absorbed by the body. There was less to fix the next implant into, so she risked amputation. The pain came from loosening implants moving within the bone, and infection.
Julie said: ‘I was spending lots of time in hospital and convalescing, and although my employers were very good, eventually I had to give up the careers adviser job I loved. I had to give up driving too.’
She had a bone graft in 2010, but fell in the garden in 2014 and damaged the arm again. Because there was so little bone remaining, her surgeon Amjid Ali, consultant shoulder and elbow surgeon at Sheffield Teaching Hospitals NHS Trust, suggested a custom-made prosthetic bone. He took X-rays and measured Julie’s humerus (upper arm bone) and sent the dimensions to the US firm that makes the replacements. The titanium alloy prosthesis designed for Julie was 21cm long and 1.5cm in diameter.
Mr Ali said: ‘Tumour surgeons have replaced the humerus following damage by bone tumours, but replacing it as a result of a fracture is very unusual. Risks include infection and damage to nerves, but Julie was suffering and could not use this arm for the simple things that all of us take for granted. We wanted to try to ease the pain, and give her back some function in the arm.’
Julie underwent the seven-hour operation at Northern General Hospital in Sheffield in December 2015.
First Mr Ali made an incision in the back of her arm from above her elbow to below the shoulder, isolating important nerves that control the wrist and hand and protecting them. Then he removed old bone graft and the upper part of the old elbow replacement, as well as the grout used to cement it in place. He removed the ball part of Julie’s shoulder, slotting the ball of the implant in place. Then he joined the lower part of the prosthesis to the lower part of Julie’s existing elbow replacement.
‘This is a clever solution for a patient who really has no other options and is in pain,’ said Duncan Tennent, consultant orthopaedic surgeon at St George’s Healthcare NHS Trust in London and Spire St Anthony’s Hospital in Surrey. ‘While a long operation carries higher risks of infection and nerve damage, for selected patients and as a last resort this is a very impressive custom-made solution to restore a patient’s independence and reduce the pain.’
Julie said: ‘Now I can use a knife and fork, lift a cup of coffee and dress myself, and best of all, the pain has eased significantly too.’