Since its founding nearly a decade ago, the University of Colorado Limb Restoration Program has helped countless patients preserve their hands, feet, arms and legs.
But there are times when a limb is damaged to the point that a patient’s best option involves a tougher decision.
“When dealing with extremities at risk, there’s a subset of people for whom amputation becomes the right choice. That’s always been a pillar of the Limb Restoration Program,” said Dr. Jason Stoneback, an orthopedic traumatologist at UCHealth University of Colorado Hospital, who founded the program.
Stoneback and his team support patients who need traditional socket prostheses, and their center is also an international leader in bone-anchored prostheses, where doctors permanently implant a rod into the bone of a residual limb through what’s called osseointegration, providing firm footing for an attached prosthesis.
The new CU Center for Prosthetics further solidifies the program’s commitment to serving patients with limb loss and serves as a center of gravity for diverse research efforts to improve the lives of amputees.
The new center, located in the University of Colorado (CU) Medicine building on the Anschutz Medical Campus in Aurora, brings specialized prosthetics fitting and user training to a dedicated first-floor space convenient to the UCHealth Orthopedics Clinic – Anschutz Medical Campus where the Limb Restoration Program team sees patients.
The space includes a main room with stairs, a ramp, and parallel bars for patient training, and a low mat for patient fittings. There’s also an exam room and a work room with tools familiar to the garage tinkerer – plus a high-end grinder for shaping sockets and a German-made alignment jig. Dan Milius, the program’s prosthetist, sees about 20 patients a week here.
Closing the prosthetics loop in limb restoration
Using traditional plaster-molding methods, as well as digital approaches starting with handheld 3D scanner, Milius establishes precise dimensions used to order custom-fit legs and, less frequently, arms, and refines them and works with patients on getting used to them. While most patients have socket prostheses, he also works with increasing numbers of bone-anchored limb patients. Often, he says, patients can book prosthetic appointments immediately after their limb-restoration orthopedics appointments a few hundred yards away on the fourth floor of the University of Colorado Hospital Outpatient Pavilion.
CU School of Medicine physical medicine and rehabilitation specialist Dr. Danielle Melton, who leads the Limb Restoration Program with Stoneback, says the CU Center for Prosthetics helps the team take care of amputees “the right way.”
“Before, I’d order prosthetic devices, and they’d go out into the community, and we didn’t have direct interaction unless the patient came back with fit issues or other problems,” Melton said. “Now I can just pick up the phone and say, ‘Hey, Dan, this needs to get fixed, the alignment looks abnormal.’ It’s really special to have it where we can work directly together and troubleshoot.”
A hotbed for prosthetics research
Research efforts by those affiliated with the new center will also benefit future patients. Bone-anchored limb research is a major focal point.
Stoneback estimates he has done more than 100 osseointegration surgeries since performing Colorado’s first in 2019. The center has served bone-anchored limb patients from 41 states and eight countries. Benefits of the approach include avoiding common socket-prosthesis problems such as skin breakdown and discomfort. Osseointegration also enables better proprioception, control, and, with lower-limb prostheses that predominate bone-anchored prostheses, a normal gait.
Melton says Limb Restoration Program researchers have published about two dozen articles related to bone-anchored limb research. The topics range from improved surgical techniques to understanding patient outcomes from the perspectives of functionality, disability, pain and how patients’ daily lives are affected after surgery – the latter the specialty of Dr. Mohamed Awad, a CU School of Medicine research instructor.
“Our group is responsible for publishing some really groundbreaking, foundational literature that’s going to shape the next decade of what we’re doing in this space,” Melton said.
Eric Earley, a PhD bionicist, joined the team this summer. His past research work has involved using machine learning in prosthetic control and improving the connections between residual nerves and prosthetics, called myoelectric interfaces.
“We’re fortunate to have researchers and clinicians working together to provide the best care for patient as well as do the best research,” Earley said. “I think the opening of the CU Center for Prosthetics is a great step forward in pursuing the goal of merging clinical care and research.”
Setting the standards for bone-anchored prosthetics
Earley and others on the bone-anchored limb research team are wrapping up an international study aimed at developing consensus about what bone-anchored prosthetic components are best for different patient profiles. Such guidelines exist for socket prostheses, but they don’t necessarily translate directly to bone-anchored limbs. As an example, Stoneback says, the connection of a bone-anchored limb into a femur is so solid that a patient may feel the whirring of certain microprocessor-driven knees.
“Very small changes in prosthetic componentry, alignment, or the stiffness of the foot can result in drastically different experiences of comfort and, in some cases, pain,” Earley said. “We hope to be able to consolidate all of this information, so that patients who have bone-anchored limbs can experience better outcomes more quickly.”
Melton says the goal remains to build a world-class program that starts with limb-preservation, continues through the most effective amputation and prosthetics approaches, and extends into long-term follow-up. That combination is extremely rare, she added.
“I think having us all together and able to collaborate in patient care and on different research projects is going to be game-changing,” Melton said.