B.C. motorcyclist who collided with deer walks again thanks to 3D-printed bone replacement
Credit to Author: Pamela Fayerman| Date: Thu, 08 Aug 2019 05:05:25 +0000
WARNING: Graphic medical image below
White Rock resident John Jefferson has been facing the possibility of a lower leg amputation since he hit a deer two years ago while on a motorcycle trip in Washington state.
Today, thanks to the merger of 3D printing and medical technology, Jefferson is walking again.
After the collision with a buck that suddenly leaped onto the highway, a major foot bone — the talus — popped out of his badly gashed right ankle and landed on the road. A few finger fractures and plenty of road rash — he was wearing jeans, not full protective gear — would be the least of his concerns.
Paramedics were urged by John’s wife, Shannon, to retrieve the bone and take it to hospital for replanting.
Riding right behind her husband on her motorcycle, she had seen the accident and even saw the bone soaring through the air. His foot had borne the brunt of the impact with a highway guardrail when Jefferson went flying off his Kawasaki Nomad. Unlike other bones in the body, there are no muscles and tendons attached to the talus so it can pop out during such trauma.
Seattle surgeons disinfected and reinserted the bone, but a compromised blood supply and constant infections plagued his recovery and his ability to put weight on his foot. So Jefferson, 71, has mostly been in a wheelchair. But he has never embraced the notion of a mid-calf amputation, which Vancouver doctors had told him might be required.
Dr. Alastair Younger (left) and patient John Jefferson, who is walking again after a transplant using a #3D printed bone replacement.
A year ago, Vancouver foot and ankle surgeon Dr. Alastair Younger removed the chronically infected talus and packed the area with “antibiotic cement.”
“That was also done as a placeholder until we decided what to do,” Jefferson said. Ankle fusion was a possibility but that would result in a very limited range of motion.
Jefferson abhorred the thought of amputation. So last year, he started relentlessly pursuing alternatives. He found an article published by Duke University about an orthopedic surgeon there using 3D printing technology to make customized replicas of bones.
The manufacturing of the prosthesis is done after CT imaging. The healthy leg and foot are imaged for a detailed view of the anatomy and then the image is flipped to create a model for the new talus.
Jefferson, an entrepreneur who has created several internationally successful companies marketing firewood bundles and non-toxic paint strippers, called the North Carolina surgeon and then connected him with Younger. “You have to be your own best advocate,” he said.
Younger had heard about the procedure at a medical conference and had been to Duke University a year ago to learn about the process. He was willing to attempt it, but since it was considered experimental surgery with a new medical device, St. Paul’s Hospital and Health Canada each had to grant approval.
“Sometimes, patients are better off with amputations, but John didn’t want that,” said Younger. “And I believe that when the consequences are pretty dire, you have to try experimental things. Sometimes, it’s the only way to realize outcomes, to do new things in medicine.”
Dr. Alastair Younger (left) and patient John Jefferson. Younger is holding a spare copy of the 3D printed ankle bone replacement and a bone model of an ankle.
The hospital agreed to fund the prosthesis. It was expensive, $18,000, but “not prohibitively so,” Younger said. Artificial limbs, joint replacements and other implants can cost far more. After Health Canada granted approval, Younger did the surgery two months ago, using a cobalt chrome implant made by a Texas company called 4WebMedical.
“They actually sent three sizes so that I could choose the best fit during the surgery,” Younger said. The other two are now souvenirs. Younger has one, Jefferson the other.
Younger said he believes the operation was the first of its kind in Western Canada.
John Jefferson receives a 3D printed replacement for his ankle’s talus bone during surgery at St. Paul’s Hospital.
“I booked extra OR time, just in case, but it all popped in quite easily so it was a two-hour procedure that went remarkably smoothly. John was only in the hospital a few days and he’s doing much better than I expected. I’m sure his positive attitude helps.”
The swelling in Jefferson’s ankle has been progressively going down and he’s walking short distances in his neighbourhood for the past month with barely a hint of what he’s gone through.
Yet Younger concedes it’s still early days for Jefferson. “We can’t assume that the infection is permanently eradicated. Sometimes it takes a few years for that.”
Jefferson is older than patients who usually suffer traumatic foot and ankle injuries, Younger said.
“Typically, these patients are in their 20s to 40s and sustain injuries during rock climbing, snowboarding, skateboarding, or falling off roofs and tall ladders while doing things like hanging Christmas lights, industrial accidents and of course motorcycle accidents.”
X-ray of John Jefferson’s ankle after the replacement bone was implanted.
Incredibly, Jefferson is still dreaming — and even betting on getting on a new motorcycle.
“My wife and I have been motorcycling for 40 years and while we understand there’s potential for danger, we’ve never had a close call before this. But yes, I’ll be wearing protective gear in the future.”
Younger, a leader at the multidisciplinary Footbridge Clinic where orthopedic and sports injury patients are getting faster treatment including imaging, consultations with surgeons and other orthopedic specialists in a co-ordinated process, predicts that 3D printing will revolutionize surgery.
Although Jefferson is his first patient to get a total talus replacement through 3D printing, Younger is upbeat about its potential.
“This kind of surgery is going to save hundreds of feet.”
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