OI Proves Best Decision for Care
January 2020 Issue
One summer afternoon 23 years ago, Donna Thornburg got out of her Suburban at a carwash in Westminster, Colorado, to open the passenger-side back door when a car hit her from behind and crushed her knees between the bumpers.
Thornburg had two surgeries on each of her knees soon after the accident, and her physicians told her then to expect to have both knees replaced. Her right knee was first replaced ten years ago. That surgery was the first of 25 operations including five right knee replacements.
The Denver Broncos
The professional football team was the catalyst to Thornburg's decision to have her amputation. She was wearing a Broncos jersey at church one Sunday when a couple asked if she'd like to attend a game. "I was so excited to tell my husband, and then it hit me: I couldn't go because my leg wouldn't bend enough to allow me to sit in the seats," she says. "That's the day I decided my leg had to go."
Thornburg had heard of osseointegration (OI) before the initial transfemoral amputation of her right leg in April 2017, and wanted the procedure, she says. "I had asked my surgeon to do it [OI] at the time of my amputation, but he couldn't because it wasn't [U.S. Food and Drug Administration] approved. I just couldn't take the pain any longer. I had so many complications, and I couldn't take any type of narcotics because I would break out in a painful rash," says Thornburg, 55, a mother and grandmother.
After the amputation, Thornburg spent the next two years struggling to find a way to live with wearing a prosthesis and searching for a prosthetist she could connect with. Both were difficult at best, she says. The socket she wore was larger than her left thigh, which made it difficult to drive, often kept her off unbalance, and resulted in constant hip and back pain, she says.
One of Five Transfemoral Amputees
Thornburg says she learned through a friend on social media about the Limb Restoration Program at the University of Colorado (UC) School of Medicine and University of Colorado Hospital in Aurora, Colorado, which was gearing up for its first-ever OI procedures in 2019.
Thornburg applied for a pre-screening program at the Limb Restoration Program at the University of Colorado Hospital, and to her surprise her application was accepted. She began meeting with the Limb Restoration multidisciplinary team-prosthetists, physical therapists, surgeons, nurses, athletic trainers-in spring 2019 to be evaluated for the procedure. "I was so impressed with everyone," she says. "They were so kind and took the time to explain the whole process, what to expect, the timeframe, costs." As preparation for surgery, the team also gave each of the patients exercises to perform at home to build strength, Thornburg says. "Everything was so thorough," she says.
She was one of five inaugural patients selected to undergo the OI procedure at the University of Colorado Anschutz Medical Campus, which included two other women and two men who had undergone transfemoral amputations from two years to 38 years ago.
Jason Stoneback, MD, is director and orthopedic complex reconstruction surgeon at the Limb Restoration Pro-gram at the University of Colorado Hospital, a program he started in 2012. "The [OI] surgery has been a game-changer for Donna," says Stoneback, who has done the procedure numerous times overseas. "Our programmatic approach is to take a concerted multidisciplinary approach to these challenging conditions and restore patients to their optimal selves."
The multidisciplinary approach is beneficial in myriad ways, Stoneback says. "Reviewing complex cases prior to the patient traveling to our institution allows us to ensure they see the right providers in a coordinated fashion."
Thornburg's first surgery was September 16, 2019, when Stoneback implanted a rod in her femur. During the second procedure on November 4, 2019, Stoneback inserted a percutaneous component in Thornburg's femur. For three weeks in November she and the other OI patients had physical therapy five days a week to adjust to walking with the implant. "We're being trained and conditioned to walk correctly, since we've developed bad habits using a socket," Thornburg says.
The Benefits of OI
Now that Thornburg is several months into having an OI implant, she says she can think of few negatives when comparing it to wearing a socket. "It's day and night difference," she says.
When Thornburg wore a socket, she says she had to allow extra time to get dressed and had to clean the liner each time she removed it. Since having OI, she can don and doff her prosthesis in a matter of seconds. Liners caused excess sweating, skin rashes, and other irritations for her. "With OI, there's no problem because there's no liner," she says.
OI has also made clothing choices easier. "My socket was bulky so I couldn't wear certain clothes, even with dresses and skirts, you could still see the outline of the socket," she says. "Now I can wear clothes without having to worry about the socket showing under them." With OI, Thornburg is pleased that her prosthesis isn't the first thing she has to dress in the morning. "I first had to dress my leg and socket, then put my pants on, then my sock and shoe, and then carefully put my other leg into my pants," she says. "Once I was dressed, I usually stayed that way all day because it was too difficult to change into anything else." Now Thornburg says, "I dress normally since I just snap on my leg."
The socket was also heavy, she says. With OI, "there's no extra weight to haul around."
The surgery has also considerably lessened the phantom pain she had experienced in her right leg and relieved her hip and back pain.
Before the surgery, Thornburg's residual limb would often shrink during the day. As a result, she'd sink into her socket, which would rub against her groin, and her femur would rub against the bottom of the socket. "Both would cause quite a bit of pain," she says. "Now with no socket, there's no pain and a lot less bulk to carry around." Also, when she sat for extended periods, her prosthetic foot would rotate. "It would be turned all the way out like a penguin," says Thornburg, but she wouldn't take the time to straighten it as that meant having to lower her slacks. "I would just walk to my car like that."
The one aspect of OI that Thornburg says she is especially pleased with is osseoperception—a perception of the environment that allows a person to perceive pressure, load position, and balance since the implant is placed in the bone. "With a socket you can't feel anything. You can't tell what kind of surface you're standing on," she says. "I could be standing on my grandkid's foot and I wouldn't even know it."
Since having OI, Thornburg says she can feel the surface beneath her foot, as well as the sensation when she taps on the side of her prosthesis. "It's an indescribable feeling," she says.
Thornburg's attitude and fortitude have never wavered. In fact, her family took a planned vacation the day after her accident, despite the injuries she received at the carwash. She says she considers herself lucky never to have had an infection in her right leg, despite all the surgeries and complications. She still needs a left knee replacement, which will come with time.
She was diagnosed with breast cancer in January 2018, and went through four months of chemotherapy, a double mastectomy, and radiation. She had reconstructive surgery in January 2019. "I am so grateful it didn't prevent me from getting picked for OI," she says.
Her determination was evident in physical therapy, as she listened carefully to the therapist's instructions as they walked together through the parallel bars. Thornburg will use crutches to get around safely for now, but she plans to stop using them as soon as she is physically able.
Thornburg says it has been the support from her family and friends and her faith that has ultimately helped her through. "So many things have fallen into place," she says. "I am a very blessed person with a wonderful husband, a great family, and an amazing God. I have so many friends who have supported me and prayed for me through this journey."
Betta Ferrendelli can be contacted at firstname.lastname@example.org.