Good Things Take Time
Mainlander Kori Stanger is a patient but determined man. It’s been a long, slow journey since losing his arm in a motor vehicle accident in 2011, but 11 years on and Kori is now the very first upper limb amputee in Aotearoa to receive an osseointegration surgical implant and to be fitted with a myo-electric (bionic) arm.
‘Good things take time,’ says the Westport battler. ‘This can now be an option for other upper arm amputees to consider and that’s a really good thing,’ says Kori.
Being the first at anything is often fraught with setbacks, pain, and frustration, and Kori can certainly testify to this. ‘There were times when I felt like giving up because it seemed like it would never happen,’ says the thirty-nine-year-old. But now that Kori finally has his new arm, he’s excited about the future. ‘I feel like I’m getting my independence back, so I’m pretty stoked about it all,’ he says.
Osseo-what?
For the uninitiated, osseointegration is the scientific term for an artificial implant that is surgically anchored and integrated permanently into the bone and has been used commonly for decades in dentistry and joint replacement surgery. For amputees a titanium implant within the bone has an adapter that protrudes through the limb so it can be connected directly to the prosthetic. This gives amputees better physical control than traditional socket prostheses. Orthopaedic surgeon John McKie believed that Kori would be an ideal first recipient of this technology.
Physiotherapist Kate May has been part of the Christchurch based Peke Waihanga (Artificial Limb Service) team working with Kori from day one. ‘Kori is the only upper limb osseointegration patient we’ve worked with in New Zealand. It happens overseas, so it’s not new, but it’s certainly been new for us. We’ve done lots of osseointegration with lower limb patients and we are now efficient and knowledgeable and getting great results, but when it comes to upper limbs, we are very much on the learning journey together,’ explains Kate.
Doing the hard mahi
Manager for Peke Waihanga Christchurch, and veteran Clinical Prosthetist, Matthias Blattner emphasises how significant this is for amputees: ‘Osseointegration provides a whole new option for trans-humeral (upper arm) amputees in terms of possible prosthetic solutions. The beauty of the implant is that you can still use the natural rotation of your shoulder joint. For patients with a traditional socket, you just don’t have that rotation anymore and rely on an artificial elbow for that function. The implant allows you to retain that movement because it’s your normal body function in control. Now that we have the capability, we want to utilise what we’ve learnt and give other arm patients the same option as Kori—it’s exciting!’
Peke Waihanga Technician Dan Gruppelaar is also buzzing from the success of the project. ‘Being able to build a high-tech arm that is going to improve someone’s life dramatically is very exciting. Kori’s arm is a one-of-a-kind (so far) and it’s been great to work with him and the team to get to this point. I think osseointegration is going to be a good solution for a lot of patients—there are amputees out there who have a lot of trouble with traditional sockets. Knowing there is another option that is massively functional is something to consider. It won’t be the right solution for everyone, but it’s a stepping-stone that could lead to an easier path for appropriate candidates to jump on board with. It’s been a really satisfying project to work on with the team.’
As well as the Peke Waihanga team, bio-engineer David White of Antivehas been an integral part of the project. ‘David worked with the surgeon to customise Kori’s implant. He comes in and helps us problem solve with Kori. It’s an evolving process and a real team effort,’ explains Kate.
Matthias agrees saying, ‘Everyone has worked really hard, and when we fitted Kori with his new arm—well it was a huge milestone completed and we are all celebrating together with him.’
Just the beginning
‘Kori’s been incredibly patient, and that patience is now paying off,’ says Kate. ‘I feel so happy for Kori that he’s finally got what he needs. But in a very real sense it’s just the beginning because the next step is supporting him to become a proficient user of the technology.’
Attached to Kori’s surgical implant is a myoelectric (bionic) arm—it’s incredible technology! Electrodes sitting on the surface of the skin detect the electrical signal that muscles give off when they contract. These signals are sent to a controller which triggers movement in the elbow, wrist, and hand. Different patterns of muscle activation control the individual movements of the components of the prosthesis. Studies show that many amputees who have undergone osseointegration experience ‘osseoperception’ which is the sensation that their prosthesis is somewhat like part of their body. However, bionic arms are heavy, expensive, need to be charged frequently, are not waterproof, and the initial learning curve for patients is steep.
Kori knows full well that the journey ahead is going to be challenging physically and mentally. ‘My left side is just not as strong as my right side anymore. The arm is about 3 kilograms so it’s going to take some hard work on my part to get used to that kind of weight hanging off my shoulder again—lots of physio. Also, my right arm has been compensating for the loss of the left one for years, and it gets quite sore—especially my elbow and wrist.’
Despite the many challenges over the past decade, Kori still wants to recommend that other upper-limb amputees consider osseointegration. ‘I was the guinea pig, and it was all new to everyone involved in the process, but the benefits are huge,’ he says. ‘Given what I can already do with the arm from the training I’ve had so far—and it’s only been a couple of days—it’s going to be epic when I’ve fully conquered the physical side of wearing the arm for longer periods. Imagine what I could do with more training and physio? I can’t wait to conquer learning how to use my new arm.’
Surprises along the way
While waiting for his new arm to be completed, Kori was surprised but pleased to find there were benefits just to having the implant surgery. ‘I could do more with the 2 inches of metal implant than some of the prosthetic arms I had tried. I can hang grocery bags on it, push myself up with, lean on it, and open certain kinds of door handles. I can even hold an onion with my implant and take the ends off and peel it with a knife using my other arm. It’s strong because it’s connected to my bone.’
When asked what he was most looking forward to being able to do again now that he has his new arm, Kori surprised himself with the significant simplicity of his desire. ‘Being a solo-Dad with two boys, I’m just really looking forward to being able to help more with the day-to-day tasks at home. It’s exciting—it’s going to be good.’
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