Recently, for the first time in the history of Ukrainian medicine, three patients in Lviv underwent osseointegration – insertion of an implant into the bone and then attachment of an artificial limb. This prosthetic technology is the dream of Ukrainian doctors, because it allows to help people with “high” leg amputations. The first operations were carried out at the National Rehabilitation Center “Nezlamni”, which operates as part of the Lviv First Medical Association. Ukrinform reporters were informed about the results and expectations of applying their knowledge.

THE NEW METHODOLOGY OF THE AUSTRALIAN PROSTHESIS GROUP

Unfortunately, due to the war and the barbaric Russian attacks on civilian infrastructure, Ukrainians are increasingly in need of high-quality limb replacements. To achieve this, they opened their own prosthetic workshop in the National Rehabilitation Center “Nezlamna” in Lviv, with the support of the Ministry of Health and the German Government. But the facial prosthesis per month that can be made here is not enough because the demand is too high. Therefore, experts began to look for new methods to make the process faster and better.

In March, Munyed Al Muderis, one of the world-renowned orthopedic traumatologists, came to Ukraine from Australia. He’s Iraqi, so he’s seen a lot of people traumatized by the war. Since childhood, she dreamed of helping the victims move again. He once reached Australia by boat as a refugee.

– The idea of ​​osteointegration, rapid rehabilitation and return to independent living. I have patients from all over the world – people who have been in car accidents, military personnel with mine and explosive wounds, as well as those suffering from infectious and other diseases. Every patient is important and deserves appropriate treatment. Al Muderis.

On his first visit, the Australian orthopedist stayed in Lviv for three days and examined more than a hundred patients who had their limbs amputated. And then back in April, so that the first Ukrainian could get the most modern prosthesis based on osseointegration technology.

In Australia, Al Muderis has already performed almost a thousand similar operations and has conducted another five hundred operations worldwide. His patients lead an active lifestyle and work without restrictions.

– Ukraine, unfortunately, is the “capital” of amputations. And there will only be more cases of limb loss. Osteointegration aims to increase the mobility of the patient. Therefore, it is very important for Ukraine to be able to carry out such operations. The advantage of osseointegration is that it gives sensitivity to the patient and can feel and distinguish surfaces. For example, walking on the grass and feeling its softness, – added the orthopedist.

FIRST UKRAINIAN PATIENT

Igor Krupnov – The 57-year-old captain of the ZSU from Dnipro. He is an Afghan veteran. In 2022, he voluntarily went to the defense of Ukraine. He fought in the south of the Kherson region, where he lost both limbs when an SUV hit a mine.

– As a result of the explosion, the vehicle blew up, landed on the roof and caught fire. Luckily the door opened and the men behind us let us out. I was taken first to Mykolaiv, then here – to Lviv. On the fifth day, he came to his senses. I’m happy to be alive. But my comrade died and I lost both legs. That was the end of my war, – the soldier recalls.

When it was time for prosthetics, doctors suggested Krupnova the newest method – placing an implant in the bone.

– The patient had high demands. He wanted to return and fit into society as quickly as possible, so they decided to try osseointegration prostheses. After all, before the Great War, Ihor led an active lifestyle, even completing a marathon in 2016. It’s important for him not only to be able to walk, but also to be able to continue running or cycling, says the head of the Nezlamni Center traumatology department. Vasil Rokyta.

According to Valeria’s wife, who was always there for her husband and dreamed of being able to walk again, daring to have the surgery was not easy.

– It was quite a difficult decision, because innovative things, especially in Ukraine, is when you can not ask others what happened. It was like jumping into a cliff and it was a big responsibility. We’ve had multiple picks since the injury, but this was very important because it affected the future. The center’s highly trusted doctors helped us decide, and we dared to “jump”. And they are very pleased, he says. valeria.

Ihor remembers the key moment was the second day after surgery, when the doctors offered to stay on the ground for the implants.

-I thought it was impossible, it hurts… But the doctors said: “Don’t be afraid, get up!” they said. And really, there was no pain! I saw blood still flowing from the wounds, the legs were very bad, but standing was normal, comfortable and relaxed, says the patient.

However, it is not possible to walk fully right away, it takes time for the body to accept the implants, the prosthesis to integrate with the bone, and the wound to heal. Six weeks after surgery, the prosthetists placed the last part of the structure – the artificial feet. Now, six months after losing his limbs, Igor Krupnov is walking, driving and even visiting the theater with his wife.

– I’m not running yet, but I’m already walking normally and even driving. I almost feel the car with my legs. These dentures are very sensitive, says Krupnov: I can feel grass, cobblestones, and even distinguish between carpet and concrete, which wasn’t the case when I tried ordinary dentures, Krupnov says.

– I bought the first “ordinary” prosthesis very hard. I looked at the man and thought it was someone else. But when I saw him standing on these prostheses and greeted me with the words, “My legs have grown back,” I knew my Igor was back. It’s a strange metaphysical feeling, and I cried with happiness that we won this war – says his wife.

After rehabilitation, the family’s plans for the future are to actively run a business, manage a country house in Dnipro and furnish an apartment in Odesa, which they bought just before the start of the First World War.

REHABILITATION IS THE PATH TO AN ACTIVE LIFE WITH PROSTHESIS

An equally important stage for returning to full walking after wearing the prosthesis is rehabilitation. Physiotherapist of the Nezlamni Center Roksolyana Shmilo describes the features of this process during osseointegration prostheses.

– When we use a classical prosthesis, we put the prosthesis on and make the patient vertical as soon as the stump heals. You should be more careful about osseointegration. During the first six weeks, 20 minutes of verticalization is performed twice a day so that the patient can transfer body weight from leg to leg and the wound itself heals completely. After the sixth week, it is much easier for the patient to maintain balance and coordination. The feeling of the surface on which the person is moving is also a big plus. The physiotherapist says the process is much faster than with conventional prostheses.

Rehabilitation is carried out twice, sometimes three times a day. The Walkbot robotic system is used to restore the walking stereotype.

– Walkbot was created in Korea, – explains the rehabilitator. – When the patient walks with its help, he automatically remembers the correctness of the step – the ability to feel the roll from heel to toe, left and right. All this has to be mastered again, and it is important for the brain to remember these algorithms. In fact, it was not designed for amputees. But when the hospital bought this simulator, I tried it for our patients, got positive feedback – and now we are actively using it for rehabilitation, especially for people with double amputations.

As for Ihor Krupnov, Shmilo is getting very good and fast results. Crutches and wheelchairs were mixed with the prosthesis just one week after the feet were attached.

– I asked him after class if he was ready to give up his chair, and he immediately replied that he was always ready. Since then, Igor is on his own: he calmly goes up the stairs, and when they recently went fishing, the grass or swamp under his feet was also not a problem for him. Very cool.

THE FUTURE OF OSTEOINTEGRATION IN UKRAINE

Osteointegration prostheses are innovations not only for Ukraine, but also for the world. However, medicine is advancing rapidly, abroad they began to perform surgeries to insert implants in the bone, not only for the lower limbs, but also for the hands. Doctors emphasize that such operations are an urgent necessity in our country, where more than 10,000 Ukrainians need prostheses due to the war.

– Only a few countries in the world have this technique: Australia, America, Germany and us. An Australian team from whom we gathered experience came to us, now we are planning to study in Germany to choose the best path for Ukraine. The Ministry of Health is currently engaged in the certification of such prostheses in Ukraine, work is underway to create a state program for the purchase of such components, as they are expensive, and the need for us is huge – he said. Lviv First Medical Association Oleg Samchuk.

Minister of Health Viktor Lyashko After performing the first operations to place a prosthesis on the bone at the Nezlamni Center, he visited patients and emphasized the need to improve osseointegration in Ukraine.

– I am proud that such modern technologies are available to our patients. This is something worth scaling up by bringing in experts. I am grateful to the doctors who responded and came. Mr. Al Muderis was the first to help our doctors begin to master the latest technology. I hope that in the near future experts from Germany and Sweden will join him. I am sure that this practice will be applied by our boys and girls who are experienced in surgical interventions in the future. We will use it as much as possible, – added Lyashko.

In addition to Ihor Krupnov, two more people were fitted with osteointegrative prostheses in Ukraine. Alexander Zhuravel – 33-year-old paramedic from Poltava. He was wounded while evacuating his comrades during a combat mission in the Soledar region on January 23 this year. Amputation was done in Kramatorsk and returned to Nezlamni Center for prosthesis. The man underwent complex surgery as he had a “high” amputation. Currently, the paramedic is waiting for his wound to heal before he can walk.

He also received his last prosthesis Yuri Ivanchenko from Bakhmut. The man was a civilian, working as a mechanic but now retired. A cluster bomb exploded in the garden near his house. At this time his house was destroyed and his owner was injured numerous times and his leg was amputated. After installing an osteointegrative prosthesis, he is already taking the first steps and is actively engaged in rehabilitation.

According to Vasyl Rokyta, the main requirement for fitting osseointegration prostheses is stump cleaning, being free from infection and inflammatory processes. But at the same time, the doctor emphasizes that the responsibility of the patient and the care of the implant in the future are no less important.

– This is not an easy matter and has many nuances, but it is worth learning and further development, – added Rokita. – If the patient walks with a conventional prosthesis but has some discomfort: the leg sweats or rubs against the stump, he/she wants more opportunities, such as swimming or running, is a candidate for osseointegration prostheses. Because really mobility, functionality, precision and our Ukrainians deserve quality prostheses!

Ludmila GrinyukLviv
Photos Anastasia Smolenko and provided by the press service of First Medob.‘Lviv union