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SALT LAKE CITY — Two veterans are participating in an important 10-year trial that involves "retraining" veterans on how to walk on embedded percutaneous osseointegrated prostheses, or POP implant.
Prior to the POP implant, the veterans had been using traditional sleeve device attachments to connect their prosthetic limbs to their remaining leg after undergoing above the knee amputation.
"We're excited to see the progress these veterans are making in this VA funded research study," says Dr. Larry Meyer, chief of research at the VA Salt Lake City Health Care System. "These first steps are amazing for the patients and our team. This is a long-term study that will (eventually) cover 10 veterans over a multiple years and, if successful, hope to be expanded to a larger number of patients. Research can take many years to complete. As researchers, we are anxious to gather our results and allow future improvements. The exciting thing about research is that we don't know the answer when we start."
Doctors say the implants should reduce the amount of energy the men exert when doing activities.
The first surgeries for the two veterans took place on Dec. 7, 2015, and involved implanting the device into the femur bone. The second surgeries took place on Feb. 8, 2015, and involved attaching a post to the femur component of the device through the skin so that it could effectively connect the bone directly to the prosthetic limb.
Most prosthetic devices are attached via a sleeve or "socket" that slides onto the exterior part of the amputated leg. When the amputees walk on the prosthetic limb that uses the sleeve, they may experience discomfort and need frequent refitting due to weight loss or weight gain. They also expend more energy since the movement for the prosthetic leg involves the muscle and not the bone. By implanting a device into the bone, the veterans can potentially experience improved function and reduced energy exertion.
The VA's Office of Research and Development has provided the necessary support and funding for 10 veterans to participate in a feasibility study. The research is part of a joint venture between VA, the University of Utah, the U.S. Department of Defense, and the U.S. Food and Drug Administration.
Although this is an exciting step forward, there are still many more phases of the research that will need to be conducted before FDA approval can be granted. Two Iraq war veterans are taking their first steps on revolutionary prosthetic legs at the Salt Lake VA. This is literally the next step for the veterans since undergoing surgeries for their POP implants in December. The veterans can now walk on their residual limbs.
"It's all about baby steps right now," said Bryant Jacobs of Herriman, who is learning to walk for the third time: first, as an infant; second, with his socket prosthetic; and now, with his POP. A roadside bomb explosion damaged his leg in Iraq 11 years ago. After nearly a decade of trying to rehabilitate the limb, he decided to have it amputated two years ago.
"We are not setting expectations, we're not doing any of that," said Jacobs. "We're just progressing."
As they walk again, they put weight on the bone, which has weakened over the years. Both veterans are seeing gradual progress.
"Hopefully in another two weeks, it will be night and day difference from what it is today," said Jacobs.
"They are really gung-ho," said Bart Gillespie, their physical therapist at the VA. However, they must take it gradually and be careful not to overexert themselves. They are being closely monitored by doctors and researchers who have been working towards this day for more than a decade.
"Bone responds slowly," said Gillespie. "So, we want to add some weight to it, let it heal. Add some more weight, let it heal."
Both veterans went through a series of tests at the VA to establish how much energy they expended using their socket prosthetics. Now, with their new POP devices, doctors hope to see a 30 percent reduction in that energy expenditure as the veterans progress.
"I wanted everything better, faster, smoother," said Ed Salau, who lives in North Carolina. "That's what I think I have now."
Salau said the new prosthetic is so much easier to take off when it's time to shower or go to bed. "I'm going to remove the Teflon pin," he said while demonstrating the function. "It's going to take about 3 1/2 seconds."
In the morning, he snaps it back on. "It's a big game changer. Just putting it on used to take three minutes," Salau said, referring to his old prosthetic leg. He also has a greater sense of feel with his new prosthesis.
"Sitting here, I can feel the slightest indentations in the tile beneath my feet," he said. With his old prosthesis, he said, different floor surfaces all felt the same.
If the trial proves successful, both veterans hope the new artificial legs will improve the lives of other veteran and civilian amputees.
"I'm doing this for a very selfish reason: for myself," said Jacobs. "But, at the same time, I'm doing it to pave the way for others."
Jacobs and Salau are the first two veterans to receive the new limbs as part of the trial. Two other veterans have now gone through the first surgical part of the procedure. During this calendar year, doctors at the Salt Lake VA hope to attach prosthetics for eight veterans if all goes well.
