The Scottish Mail on Sunday

How a bionic bone im­plant could give arthri­tis the el­bow

- By Carol Davis

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.’

 ??  ?? Pi­O­NEEr: Julie Martin is the first per­son to have the ti­ta­nium arm bone re­place­ment. Below: an X-ray show­ing the pros­the­sis
Pi­O­NEEr: Julie Martin is the first per­son to have the ti­ta­nium arm bone re­place­ment. Below: an X-ray show­ing the pros­the­sis

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