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Transfemoral Osseointegration – a self-case study and physiotherapy assessment

Jul 15, 2022 |

Dr. Rachel Gunn

Twenty-three years ago (in the UK) I had a motorcycle accident resulting in amputation of my right leg above the knee and complete paralysis of my right arm (as a result of pre-ganglion brachial plexus avulsion). At the time (1999) I looked into osseointegration and concluded that there were too many poor outcomes to take this option seriously. I continued my life with a regular prosthesis – tried several different socket ‘styles’ and functioned quite well. I just got on with my life. I was not super active, but I wore my prosthesis all day every day and was able to work and study without too many problems.

After a couple of career changes, I trained as a psychotherapist and got my PhD five years ago. I am a researcher so I never do anything lightly – I need to know what I am getting in to and I need to understand what the possible outcomes might look like. Because I am also a psychotherapist, I value all my thoughts and feelings around the process and take myself seriously in that regard. I see myself as a realist, although some people might say I’m a pessimist. I think through every outcome and must be ok with how I feel about it. As you can imagine this makes personal big decision-making processes effortful and time consuming. At the Amputee Coalition conference in 2016, I met Munjed Al Muderis and looked at the results he was getting with osseointegration. His say-so and anecdotal positive stories did not give me enough evidence to make a decision – although one of my fellow travelers, who met him at the same time, had trans-femoral osseointegration 3 months later travelling from the UK to Sydney to do it. So, the research started and culminated in me opting for osseointegration in London in June 2019. Some family members and friends were concerned – especially when I had a pre-op party which I referred to as the “I might die on the table” party!


I did my post-op rehab at Dorset Orthopaedic (in the UK), and my physiotherapist (Beth Langley) and I decided to write a (hopefully) publishable paper about the experience. The paper was published in Prosthetics and Orthotics International.

In the paper, we provide an insight of the first 18 months of rehabilitation after insertion of an osseointegration bone anchor from both the physiotherapist and patient perspective. Beth followed a specific protocol during the first part of the recovery stage, and I kept records of subjective experiences over that same period. Loading and physiotherapy were completed in line with the protocol for the first twelve-week phase, including successful fitting of the prosthetic limb on the 12thday. Physiotherapy and other interventions evolved to meet my needs over the 18-month period. Unforeseen setbacks (abscesses and inflammation/enthesopathies) slowed this process to some extent. Nonetheless, I consider the overall outcome to be good. Our hope is that findings from this research can be used to help inform and improve future rehabilitations for osseointegration patients.

Join me and learn more during my live session during the Amputee Coalition 2022 National Conference on Friday, August 12 at 3:45pm PT.