On Easter of 2009, an explosively formed penetrator (EFP) struck an eight-wheeled armored fighting vehicle of the 2nd 104th Calvary of the U.S. Army. Inside, soldier Brian Miller’s legs received the brunt of the hit.
Fragments embedded in both of Brian’s legs, shattering his femur. A bolt lodged into his right leg. When Brian required more treatment than the main base hospital could provide, he was transferred to a Baghdad medical center and then to a hospital back in the U.S. After 13 reconstructive surgeries, Brian received difficult news: He needed an amputation.
Brian used a prosthetic leg for a decade, but it began to cause him difficulties. It would lose suction in certain positions, causing him pain and slowing him down. The prosthesis couldn’t keep up with Brian’s active life.
Brian consulted with a fellow military veteran, Dr. Joseph Hsu, vice chair of quality of Atrium Health Musculoskeletal Institute, professor of orthopedic trauma and director of the limb lengthening and deformity program, and associate dean for research, Wake Forest School of Medicine. Hsu, a graduate of the U.S. Military Academy at West Point, was a trauma surgeon in the U.S. Army before coming to Atrium Health. He brings leading-edge battlefield innovations to his civilian patients, such as the Return to Performance Pathway. Another one of those innovations – osseointegration – would give Brian the full use of his prosthetic leg again.
What is Osseointegration?
By the time Brian came to the Musculoskeletal Institute, he’d already done his homework, learning about osseointegration and finding Hsu, a surgeon with expertise in it. When he initially met with Hsu, the two veterans discussed the difficulties Brian experienced with his socket prosthetic.
“Brian was essentially outperforming his socket. He was having problems with pain and heterotopic ossification, which is bone that grows where it doesn’t belong and can be a complication of a blast injury,” Hsu says. “It was interfering with his ability to function well in a prosthesis. Brian wants to do all kinds of things. He wants to cycle; he wants to hike. And those weren’t possible for him in that situation.”
The solution was osseointegration, which is an option for someone whose prosthesis doesn’t perform well in its socket. About a fifth to a quarter of people with prosthetics report having problems with their socket that limits their functioning, like Brian. They might feel heat or swelling and sweating in their socket, ingrown hairs, rashes and daily pain.
The technology of prosthetics has advanced greatly in the past twenty years, but some people still experience challenges with the connection between the limb and the prosthetic. With osseointegration, the prosthetic fixes directly to the bone and offers these patients another option.
“The main thing that patients report with an osseointegration compared to a socket-based prosthesis is better control of the prothesis. They feel a more efficient transfer of power between body and prosthetic,” Hsu says. “They get something called osseoperception, which means they can actually feel their limb in space because it’s attached to the bone. They feel like it’s part of their body.”
A Leader in Osseointegration
Osseointegration is an innovative technology from Europe that came to the US through military centers then entered to the civilian health care space in recent years, and the Musculoskeletal Institute is among the few in the region that offer this procedure. Hsu and his team have become national leaders in providing this care.
Hsu believes that embracing new technologies is essential to offer patients the options they need to live full, active lives, even after a traumatic injury. Hsu also believes that collaboration, not competition, serves patients and doctors best. Atrium Health Musculoskeletal Institute hosts the annual national Global Collaborative Congress on Osseointegration, bringing together experts across specialties to discuss innovations in osseointegration. The diversity of providers spans the entire continuum of patient care, including surgeons, robotics engineers, patient navigators, physical therapists and rehabilitation doctors.
“There’s an African proverb, ‘If you want to go fast, go alone. If you want to go far, go together.’ And that’s our goal,” Hsu says. “What we do with this conference is to make this work collaborative, not competitive. We invite centers in our region and even the world to come together to share best practices and collaborate in research studies.”
Onto Brian’s Next Adventure
While many people travel to Atrium Health Musculoskeletal Institute for osseointegration from other cities, Brian – who lives in the Charlotte area – was able to come home for his surgery.
“Brian had been evaluated at Walter Reed Army Medical Center, but he and his wife wanted the osseointegration to be done in their own community, so they came here for that care,” Hsu says.
Now, after Brian’s osseointegration, he has a prosthesis that can keep up with him – which, given Brian’s adventurous spirit, is quite a feat for that prosthesis. Just this summer, he completed the Bear Tooth Challenge, a three-day, 168-mile bike ride in the mountains, riding an upright bike.
“This was an amazing journey, and it was all because this amazing group at Atrium Health Musculoskeletal Institute came into my life,” Brian says. “I’m looking forward to all the adventures to come.”
And in Charlotte, Brian’s got a team continuing to cheer him on.
“Brian is blurring the lines between human and machine. He’s taking this limb to the limit,” Hsu says. “Riding in the mountains on a conventional bike is almost unheard of for a transfemoral amputee. He joins combat veterans’ groups on off-grid hiking, fishing and camping trips. Brian is determined live his life without limits.”
Learn more about osseointegration at Atrium Health Musculoskeletal Institute .
