Getting off to a good start with osseointegration

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Starting off on the right foot with l’ osteointegration

A new surgical approach allows amputees to overcome the discomfort that traditional prostheses can cause.

Pierre Marinier back on the hiking trails.

Pierre Marinier had already stored his motorcycle for the winter, on November 7, 2020, when the sun began to warm the Laurentians region, where he lives with his wife.

The couple then decides to take the Kawasaki out for a last ride in the beautiful colors of autumn.

I had it all glued back, and it was holding me like that with his arms, and I felt so good, remembers Mr. Marinier with emotion.

But this romantic walk will turn into a tragedy. A van coming from the opposite direction will hit them.

I felt an impact on my left side. The lights went out. I woke up, I don't know how long later, on my back in the ditch, he says. I took off my helmet, raised my right hand, my right foot, my left leg and there I saw that I had no more foot.

Pierre Marinier had his left leg amputated the same evening at the Hôpital du Sacré-Coeur in Montreal, where the couple was transported after the accident. His wife, in even worse shape, spent a month in the hospital, and also had her leg amputated.

Before undergoing osseointegration surgery, it took Pierre Marinier about ten minutes to put on his prosthesis.

In the months that followed, Mr. Marinier had to start from scratch. At the dawn of his sixties, then an aeronautical painter in a Mirabel company, he left the accommodation he had occupied for 26 years to settle in a more appropriate apartment on the ground floor. Changed car too, to adapt his driving. And above all, relearned to walk with a prosthesis.

No challenge seems to resist him. To stay active despite his disability, he washes cars in a friend's body shop in Saint-Eustache. I don't call that working, I'm having fun, jokes the one who obviously has a marked interest in anything that rolls.

But here it is: as soon as it activates, understood with a cloth in his hands, his prosthesis quickly becomes uncomfortable.

When I exercise a lot, I sweat a lot and my stump also gets all sweaty. And then all the silicone [in my prosthesis] gets soaked. There I can't do anything anymore, I have to take it off, dry it, he describes, demonstration in support, pouring several milliliters of sweat from the socket that surrounded moments ago what's left of his thigh.

Amputees have prosthetic problems that can be dangerous. Artificial limbs become unstable, or may cause sores. For Pierre Marinier, this is one more handicap in resuming his activities.

In order to remedy this, a team of caregivers in Montreal offered him an option. An innovative surgery that would allow him to get rid of the socket of his prosthesis for good.

In consultation, Dr. Robert Turcotte shows on an x-ray how the implant will fit into Pierre Marinier's femur during osseointegration.

Oseointegration consists of install a permanent metal implant in the femur bone, at the end of which amputees can simply attach an artificial leg.

We put a piece of metal through a bone which will come out through the skin and which will make it possible to attach a prosthesis. We use this among amputees to avoid wearing a socket, which is a kind of straitjacket that we put around the thigh or the leg to contain and hold the limb on the prosthesis. It's the same principle as a dental implant where a small piece of metal is implanted through the gumline and then a ceramic tooth is placed on top, explains orthopedist Robert Turcotte, of the University Center of McGill Health.

Pierre Marinier did not hesitate long before opting for this surgery. Dr. Turcotte operated on him on May 10. A surgery without complications. During the operation, the most frequent complication is a fracture. As it is an implant that is pressurized into a bone that is often osteoporotic because amputees do not use their bone much for walking, there is a risk of fractures. Fractures that are usually minor, which delay loading a little bit but which do not require very complicated treatments, specifies the surgeon.

Pierre Marinier can now walk in the forest without worrying that his prosthesis will cause him problems.

Patients should then gradually resume, over a period of a few months, putting weight on their leg. In the case of Pierre Marinier, rehabilitation went smoothly.

We found him a few weeks after his operation, at the Gingras-Lindsay Rehabilitation Center in Montreal, where the team from the osseointegration clinic is supervising his recovery.

The difference with our meeting at the body shop is striking: freed from his socket, he can now with a simple click install his prosthesis at the end of the stem that comes out of his leg, rather than spending ten minutes fix it on his stump.

Clinic staff check the condition of the wound around his implant. A metal rod that permanently crosses the skin of the thigh is not trivial, and this is the main drawback of this technique.

Given that there is an opening between the stem, the skin and the bone, one can have bacteria which infiltrate and which will lead to an infection. In about two-thirds of cases, the infection is minor, says Dr. Turcotte.

It can also happen that people, more rarely, get an infection more serious, deeper, such as an abscess, or the infection is more severe and requires intravenous antibiotics. The ultimate infection is the deep infection of the bone which would require removing the implant, but that happens very rarely, adds the orthopedist, who ensures n never encountered this situation before.

The clinic's caregivers also take advantage of Pierre Marinier's visit to verify a potential advantage of osseointegration: osteoperception. They place an object the size of a small pebble on the ground in front of him. Supported on crutches, Mr. Marinier then steps on it with his artificial foot and discovers, dumbfounded, that he feels the relief through the bone of his leg.

It's crazy, I really feel the little rock under the sole of my foot!, he enthuses.

For people who haven't felt their feet for years , it's going to allow them to know better than before where their foot is in space, to walk outside longer, to wear their prostheses longer, and then to really function more normally and to to have a better quality of life, explains physiatrist Natalie Habra, who observes the scene.

For that and for the general comfort associated with the implant compared to the prosthesis which embarrassed before, Mr. Marinier does not regret his choice. It's liberating, he says. It's almost like having my leg back. He has now got rid of the crutches he used during his rehabilitation and goes about his activities almost as before. He even started washing cars again.

The report by Gaëlle Lussiàa-Berdou and Yanic Lapointe is broadcast on the program Découverte on Sundays at 6:30 p.m. on ICI Radio-Canada Télé.

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