A simple invention saves patient’s leg from amputation
When Christopher Columbus approached Isabel, the Queen of Spain, asking her for permission to lead an armada of ships on a course that would take them west ‘ everyone laughed and asked why he should be the one lead them.
“Well then, let us agree, that whoever can balance an egg on its head, can go,” Columbus is reported to have said.
Everyone tried, but the egg kept toppling over. Columbus gripped the egg in his hand and slammed it onto the table, partly crushing the shell. The egg remained upright. Everyone laughed and said it was simple – anyone could do it, to which Columbus replied: “Well, why didn’t one of you do it?”
Seeing a simple idea and “storing it because you never know when you’re going to use it” is what led to University of Cape Town (UCT) lecturer Dr George Vicatos to design a device which has saved a 18 year old cancer patient’s leg.
A Senior Lecturer at UCT’s Department of Mechanical Engineering, Vicatos and his team worked against the clock to design the endo-prosthetic replacement.
It all started when Groote Schuur Hospital’s Dr Keith Hosking met with Vicatos hoping that the engineers could design a cheaper, local alternative to the expensive UK-produced implant (prosthesis).
The patient and hospital were unable to afford the import at about R70 000 a shot (excluding medical costs).
Vicatos’ commission was to come up with a replacement “bone” that would slot in between the top, remaining part of the femur and knee.
They designed and manufactured a novel prosthesis that cost less than R2 000 (including almost R500 for shipment of the medical grade titanium rod’s material that needed to be imported) instead of R70 000 for a United Kingdom import that operates in a similar fashion.
Vicatos and the team designed titanium “stem” (rod) to replace the cancerous part of the femur (thighbone) that doctors planned to cut out.
The other most likely option included amputating the entire leg, or replacing the cancerous bit with a segment of cadaver bone, fusing this with the knee joint ‘ a procedure with a high complication rate.
In the end the young patient’s knee was sacrificed and an artificial knee implanted, allowing it to be “screwed” onto the rod which was in turn inserted into the remaining, top half of the femur and held in place with a bracket that works on the same principle as a rawl bolt.
What makes the story even more extraordinary is that the technical officer Len Watkins completed the last pieces on the day before the scheduled operation. Vicatos and Hosking completed the “trial” run of inserting the device at 11pm. “I also only made the tools to insert the device the night before,” Vicatos said.
In a five and a half-hour operation, Hosking and his team opened up the patient’s leg, removed the cancerous bone, cut the bottom half of the femur and replaced it with the implants. Inserting the actual implant took 15 minutes.
Hosking said the patient had responded well and should retain full function of his leg, despite the fact that he had lost two thirds of his femur and had to have his knee replaced.
“Amputation would probably have been the sole therapy available to this patient,” Hosking said.
Vicatos said: “I must admit that I had tears in my eyes when it was all over. I felt like hugging the patient. On Tuesday I saw him and shook his hand. It is very beautiful to see him like that and know he is going to walk. It is so important for people to feel whole and retain their mobility and independence.”
He said UCT had a of patent on the prosthesis adding that he believed this was the beginning of bigger things.
“It’s cheap and can be mass produced. It can also be universally used for any long bone in the arm and leg.”
Hosking said he believed South Africa had no choice, but to start utilising its own resources as the exchange rate made imports unaffordable for the majority of people.
In four weeks time the surgical team with reconvene for a similar procedure on a 16 year old boy after the engineering department imported material for a further five devices.
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A simple invention saves patient’s leg from amputation
by Health-e News, Health-e News
March 23, 2001