COVER STORY
The Surgery
While Bailey-Smith is the first person in United States to have an osseointegration completed for a prosthetic limb, physicians in Europe and Australia have been conducting them for years with great success. The first procedures date back to the early 1900s, but osseointegration did not become viable until the latter half of the 20th century.
OCTOBER 2014 | O&P ALMANAC
PHOTOS: Ronald W. Hillock, M.D. and Nevada Orthopedic & Spine Center, AOPA
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Osseointegration is frequently used by dentists to give patients dental implants. For Bailey-Smith’s surgery, the concept is similar: The metal implant, pounded into the bone, functions like her biological leg because it is integrated with her musculoskeletal system. The process requires multiple steps. First is the amputation, which takes about a year to heal. Later comes the insertion of the stem into the bone and creation of a stoma, which has a small pocket to collect drainage. Finally, the stem is coupled to an abutment device that allows for the pairing of the stump to the prosthetic limb. While the multistep procedure takes time, Hillock believes it can revolutionize how prosthetic devices are fitted in the United States. He says he can perform the surgery for a fraction of the price that his European counterparts are charging. Bailey-Smith’s procedure cost less than $50,000 and was covered by her insurance. The same procedure in Europe costs about 140,000 Euros (roughly $177,647). But not everyone qualifies for osseointegration. People with diabetes, peripheral
vascular disease, and ongoing infectious disease are not candidates because these conditions make it difficult for them to heal properly. Hillock first became familiar with osseointegration when he worked as a doctor in the U.S. Army, during the early part of his career. When he was deployed to Bosnia, Kosovo, Macedonia, Iraq, and other areas, he often had to perform surgery in harrowing conditions, amputating a limb on the side of the road or removing a bullet in a surgical theater without electricity or running water. Seeing so many soldiers living as amputees convinced him there must be a better way to provide prosthetic limbs. “I want OI for battle amputees,” he says. “Pain-free, fluid, and effective gait pattern. What’s not to like?” After hearing about osseointegration, he sought out doctors who performed the procedures to learn more. He even dug into the history. After interviewing doctors, prosthetists, physical therapists, and patients, Hillock says that he understood the strengths and limitations of the procedure. He learned from other’s mistakes. While he believed that osseointegration provides better mobility and health for lower-limb amputees, no U.S. insurers initially seemed interested in funding an experimental therapy. And, he also needed to find a patient who