Selected Podcast
How Osseointegration is Restoring Freedom to Amputees
Dr. David Doherty and Dr. Danielle Melton discuss Osseointegration and how it is restoring freedom to amputees by offering better quality of life through improved function and mobility.
Featuring:
Dr. Doherty is an assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
Dr. Doherty is a board eligible (American Board of Orthopedic Surgery) orthopedic surgeon who joined UT Physicians orthopedics team after completing a fellowship in adult reconstruction at Duke University School of Medicine in North Carolina. He graduated from McGovern Medical School where he was inducted into the prestigious Alpha Omega Alpha National Honor Society. He then completed a residency in orthopedic surgery with The University of Texas at Houston in the Texas Medical Center. During his residency, he was selected to represent the program at the American Orthopedic Association Emerging Leaders Program, and served as administrative chief resident.
Dr. Doherty has been actively participating in and publishing research since he was a premedical student in college. His research has been published in scientific textbooks, national peer reviewed journals, and has been presented at national meetings. He is a member of the American Academy of Orthopedic Surgeons, and the American Association of Hip and Knee Surgeons.
He also spends considerable time traveling on medical outreach trips to developing nations, and has most recently spent time performing surgery in Baghdad, Iraq and San Salvador, El Salvador. Additionally, he spent elective time during his residency traveling to Sydney, Australia to complete a short fellowship observing the techniques of osseointegration surgery.
Dr. Doherty is a 4th generation Houstonian. He loves spending time with his wife, Amy, and their three children, at the many parks, museums, and restaurants the city has to offer.
Dr. Melton is an affiliated physician at TIRR Memorial Hermann and Memorial Hermann-Texas Medical Center. In the acute setting she evaluates and treats patients both before and immediately after amputations, coordinating care between the surgeon and the rehabilitation team. Her patients are followed long-term at the TIRR Memorial Hermann Outpatient Medical Clinic to provide comprehensive continuity of care.
A clinical assistant professor at the University of Texas Health Science Center-Houston, she is a frequent guest lecturer and is involved in research in the area of amputations, prosthetics & orthotics, orthopedic trauma and limb loss prevention. She is a member of the American Association of Orthotics & Prosthetics (AAOP) and the Amputee Coalition, where she is an active member of the Scientific Medical Advisory Board.
As a faculty member of the University of Texas, she serves as the chairman of the Continuing Medical Education committee for the medical school. She is on the Medical Advisory Committee for the BCM Masters in Orthotics and Prosthetics Program and is also the Director for the Amputee Trauma Rehabilitation Fellowship supported by TIRR in conjunction with the Trauma Institute at Memorial Hermann level I trauma center.
David Doherty, MD | Danielle Melton, MD
David Doherty, MD, specializes in hip and knee replacement surgery. He also performs partial and total joint arthroplasty. Dr. Doherty offers patients customized treatment plan utilizing anterior and posterior approaches to the hip, muscle-sparing approaches to the knee, and the most advanced technology, including robotic joint replacement surgery. His goal is to enhance patient experience and optimize outcomes.Dr. Doherty is an assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
Dr. Doherty is a board eligible (American Board of Orthopedic Surgery) orthopedic surgeon who joined UT Physicians orthopedics team after completing a fellowship in adult reconstruction at Duke University School of Medicine in North Carolina. He graduated from McGovern Medical School where he was inducted into the prestigious Alpha Omega Alpha National Honor Society. He then completed a residency in orthopedic surgery with The University of Texas at Houston in the Texas Medical Center. During his residency, he was selected to represent the program at the American Orthopedic Association Emerging Leaders Program, and served as administrative chief resident.
Dr. Doherty has been actively participating in and publishing research since he was a premedical student in college. His research has been published in scientific textbooks, national peer reviewed journals, and has been presented at national meetings. He is a member of the American Academy of Orthopedic Surgeons, and the American Association of Hip and Knee Surgeons.
He also spends considerable time traveling on medical outreach trips to developing nations, and has most recently spent time performing surgery in Baghdad, Iraq and San Salvador, El Salvador. Additionally, he spent elective time during his residency traveling to Sydney, Australia to complete a short fellowship observing the techniques of osseointegration surgery.
Dr. Doherty is a 4th generation Houstonian. He loves spending time with his wife, Amy, and their three children, at the many parks, museums, and restaurants the city has to offer.
Dr. Melton is an affiliated physician at TIRR Memorial Hermann and Memorial Hermann-Texas Medical Center. In the acute setting she evaluates and treats patients both before and immediately after amputations, coordinating care between the surgeon and the rehabilitation team. Her patients are followed long-term at the TIRR Memorial Hermann Outpatient Medical Clinic to provide comprehensive continuity of care.
A clinical assistant professor at the University of Texas Health Science Center-Houston, she is a frequent guest lecturer and is involved in research in the area of amputations, prosthetics & orthotics, orthopedic trauma and limb loss prevention. She is a member of the American Association of Orthotics & Prosthetics (AAOP) and the Amputee Coalition, where she is an active member of the Scientific Medical Advisory Board.
As a faculty member of the University of Texas, she serves as the chairman of the Continuing Medical Education committee for the medical school. She is on the Medical Advisory Committee for the BCM Masters in Orthotics and Prosthetics Program and is also the Director for the Amputee Trauma Rehabilitation Fellowship supported by TIRR in conjunction with the Trauma Institute at Memorial Hermann level I trauma center.
Transcription:
Caitlin Whyte (Host): Advancing health, personalizing care at Memorial Hermann. This is our mission. This podcast shares the science and stories behind those efforts. Today we're interviewing Dr. David Doherty and Dr. Danielle Melton to discuss how osseointegration is restoring freedom to amputees by offering better quality of life through improved function and mobility.
Dr. Melton, start us off here. Just what is osteointegration?
Danielle Melton, MD (Guest): That's a great question. So, osseointegration was a term that actually has been around for about 30 years and it started more in the dental implant realm, but it's really moved more into amputation and limb loss. Another term that we use is direct skeletal attachment. And the idea is that using an implant that goes directly into a long bone and then having a trans continuous connector allows amputees the ability to have a prosthesis without a socket. And a socket is really the most challenging interface or fit or difficulty that people have with wearing a prosthesis. So, for many people, osseointegration allows them to be able to use the prosthesis, whereas before they may not have been able to do that.
Host: And Dr. Doherty is osseointegration a common procedure for amputees? I mean just how many healthcare systems
Caitlin Whyte (Host): offer osseointegration procedures?
David Doherty, MD (Guest): So OHI is not a common procedure for amputees. It's becoming more popular and becoming more visible in the orthopedic and limb loss community. However, the first procedure for an amputee was performed in 1990 by Dr. RIckard Brånemark. And since that time, he has been perfecting his technique and implant system and making the improvements that were necessary and were became evident as he started to hone the procedure down. And now we finally entered into the phase of this procedure where we have an implant system that is FDA approved for this indication. So, I think that in the future osseointegration will become a much more approachable and much more mainstream treatment for these patients as.
Talking right now, there's only a handful of centers in the country and I'm being a little vague about that because it's tough to nail down exactly how many centers are doing this. There are some surgeons that have done one and really have a plan to continue the program, but in terms of main centers where the focus is on osseointegration and providing osseointegration for amputees, I think that the Memorial Herman Center is, is unique in it, in the sense that we have our University of Texas physicians who are focused on both the rehab and the surgical procedure.
And so we are able to offer them a comprehensive care package for their amputee osseointegration needs. Not only is the surgery incredibly important to complex and unique, but the rehabilitation needs for these patients are incredibly unique as well. And so one doesn't work without the other and that's sometimes the barrier for places in the country that do not have as robust of a system, that has the expertise in the physicians and also in the hospital system to provide this level of care for patients. So, it's so unique and complex. So, not many people are performing the procedure at this time, but part of our goal is to demonstrate it's effectiveness and to demonstrate the improvements in patient and quality of life that they experienced. So we can bring this more to the forefront and, and hopefully continue to improve the.
Host: Now what type of patient makes a good candidate? We'll go back to you. Dr. Melton.
Dr. Melton: There's lots of people that have limb loss and, and we really do need to be fairly selective in who is appropriate for osseointegration. There are some risks involved with a procedure like this. One of the significant ones that has been a concern for a delay perhaps in ensuring that this goes through the proper FDA approval channels, is the risk for infection. And so in selecting the right patient, you want to make sure that they meet certain criteria when selecting a patient that we want to make sure that they're skeletally mature.
So usually it's someone of adult age, at least skeletally. And then to make sure that they don't have other significant comorbidities or risk factors that might prevent them from being a good candidate for this. As Dr. Doherty mentioned, one of the things that we really strive to do in our team approach is to be able to screen patients appropriately.
We have an osseointegration clinic once a month. During that process, we evaluate patients who might be good candidates. Typically that starts with people who are having, currently having difficulty with their prosthesis. A lot of times having to do difficulties with their sockets fit. So in this clinic, we have obviously Dr. Doherty as a surgeon, myself as the rehabilitation doctor, and then a physical therapist with expertise in limb loss and in particular, osseointegration and the rehab that goes behind that. And then we might also look at patient's history and other medical issues that might complicate anything, but we can answer a lot of the questions that patients have in this setting with a lot of the experts that are in the room.
We take some time to go through imaging, to see if their limb is appropriate. And do other medical workup that would allow us to see if they had any other, the risk factors that I mentioned. So, I think that that's one of the advantages to looking at this from a comprehensive team approach. And one of the things that we really strive to improve upon here.
Host: Sticking with you. Let's talk about that team. What is your role in the Ojai program at Memorial Hermann?
Dr. Melton: As I mentioned, I'm the Limb Loss Director for the Amputee Program at TIRR, which is the Rehab Hospital in Houston. And I have for the last 15 years had an Amputee Clinic. So I have a pretty large patient population where I can work with amputees and fit them with prosthetic devices and really kind of look at them from continuity of care issue.
Long-term my role in the osseo integration. Piece of this is to really maybe have the direct initial contact with patients to the, whether or not they are appropriate for us to integration and then refer them into the Osseo integration group for that team approach. Dr. Doherty and I work closely together as he is, as the surgeon, and then the rehab piece, following the surgical procedure, whether it's, prehabilitation leading up to that in between the two different stages.
And then long-term rehab care post-op to start with a gait training and then just following them throughout their lifetime. And Dr. Doherty, tell
Caitlin Whyte (Host): us, please also about your role.
David Doherty, MD (Guest): So for my role in the Osseo integration program, I work closely with the rehab team. And as Dr. Melton was mentioning, she has a closer relationship with a larger amputee population and through her work for more traditional amputee care, she.
Developed a relationship with a lot of these people and has developed a reputation also that draws people in seeking kind of the best rehabilitation care for, for their limb loss and in working with them when they are starting to have difficulty with their socket mounted prostheses, and are struggling to obtain the ideal.
For attaching their prosthetic leg to their residual limb. They start to ask her if there are other options. And fortunately, during my residency at the university of Texas here in Houston, I had the opportunity to go and spend about three months doing a mini fellowship with one of the pioneers of Osseo integration.
So I learned the techniques and. The ins and outs of certain implant systems and things of that nature, and then performed further training and joint replacement, which is actually, there's a lot of corollaries to Osseo integration because just to back up a little bit, the term Osseo integration, Has been existence in orthopedics for 60 or 70 years now.
And it is a descriptive term of the bone physically growing into metal and becoming biologically fixed to metal. So the surgery, Osseo integration relies on the principle of Osseo integration of bone growing into metal to do it. And that's kind of where the name comes from. So. Taking all of these little pieces of training that I've had through my career.
I found myself in the unique position where I had a big clinical interest in bringing Osseo integration and making it more visible to Texas and to Houston and the university of Texas and Memorial Hermann were very supportive and they helped me and Dr. Melton start to. Lay the groundwork for creating an osteo integration program.
And so not only have we both been very involved with the kind of behind the scenes process of making sure the implant system is approved in the Memorial Hermann system, making sure the billing folks have weighed in and gotten some financial considerations taken care of. That's sort of my background role in Osseo integration and the, I guess, nuts and bolts of how I fit into the clinical aspect of it is I, I perform the surgeries.
And so once we have a patient that is motivated and has met the indications for surgery, the process is about a six month process. We see them in clinic. We bring them to surgery. Perform the first stage, three months later, we perform the second stage and then they enter their more dedicated rehabilitation phase.
So throughout that whole process, I'm present doing the procedure, making sure that the postoperative care is coordinated and making sure that the patient's surgical needs are met. And this. Obviously done with my usual surgical team that is works at a, at a place that is regarded in the region as essentially the top place to get orthopedic elective cases done, particularly with things like joint replacement or complex orthopedic procedures.
So we have a team of surgical technologists, anesthesiologists, and rehabilitation specialists all within the hospital system. Perfectly trained to take care of these patients needs with essentially just a little bit of extra education from Dr. Melton and myself about the unique needs of the Osseo integration patients.
So it's a, it's a really great, it's been really fun to watch it all come together. Not only my training. That I spent a lot of extra time doing unique things to give myself the expertise to perform these procedures, but also just seeing all of the behind the scenes work that the professionals at Memorial Hermann and university of Texas have, have put into this to make it all happen for these patients.
Caitlin Whyte (Host): Where would you say that OHI fits into a patient's journey? Dr. Melton and what is so
Danielle Melton, MD (Guest): rewarding? Yeah, that's a really great question. I'm glad you asked it. You know, I've had an opportunity now to, to probably have more than 30 patients. Who've had osteo integration in my practice, whether they've gone abroad to have it, or whether they've had it at our facility since we've started doing it within the last year.
When you talk to patients about this, they will tell you, this is life-changing. They will say that their quality of life is significantly improved. They're able to wear their prosthesis longer. They're have a significant improvement in their quality of life and the amount of time that it takes to put on their prosthesis or take it off.
They're able to walk longer distances. They're able to feel the ground underneath them. That's a term that we. Coined that's called Osseo perception. And for, for many of them, they'll also say that they have a decreased risk of falling because they can feel what they're stepping on. And so, yeah, it's exciting to watch and to see them get excited about this and, you know, for, for us, it's, it's having the ability to really participate in that process to get them to a better place.
Caitlin Whyte (Host): Dr. Doherty. Tell us about the benefits of Ojai, as opposed to the more common prosthetics and procedure
David Doherty, MD (Guest): options. I see the benefits of osteo integration and, and some of my most memorable moments in, in my career have been watching some of these patients walk on their prosthetic limbs after spending time in either a wheelchair on crutches.
Potentially have lost hope in, in their quality of life. So those have been some of the most rewarding patients I can see. I mean, just watching people walk again is, is a incredibly moving thing to behold, but I readily admit that osteo integration is not for every patient. So there are a lot of limb loss patients out there.
Do really well with sockets and they do really well with their prosthetic limbs and that's fantastic for them. And so when we enter into this subset of patients that are struggling with their prosthetic fit or their inability to, you know, keep their prosthesis on for extended periods of time or they're having falls with it once.
We're able to start talking to those patients. It's pretty, pretty fun to start talking to them and explaining to them that there might be a better way to have their prosthetic limb attached to them and the kind of excitement or the hope that that gives them sometimes is, is what this patient really needed psychologically to really get motivated, to, um, continue on, to see.
Possibility that they could, you know, return to their work or their job, or be the type of mother or father to their kids that they want to be. And, and things like that. So some of the benefits of osteo integration are that we do not use the socket. And so specifically talking about this. You know, it's a common story that a lot of the Osseo integration or rehabilitation specialists talk about that these prosthetic limbs that we have now have, I mean, essentially.
Military jet technology and on they've got microchips and they've got robotic processors in them and things like that. But then we attach them to patient's limbs in the same way that they were attaching prosthetic limbs in the ancient Greek or Roman times. There's hieroglyphics that show people with sockets, with fake legs attached to them.
And so it's a. Very much the weak link in the system at this point. So if you are having challenges with sockets, this completely eliminates the socket. You don't have to, uh, try and obtain a suction fit or try and jam your leg into a bucket essentially. And why. Our technology with sockets has improved.
There are still definitely patients that no matter what we do, they are not going to be very well served by a socket. And these are patients that have large amounts of scarring on their limb, or they might have residual tissue that is preventing them from utilizing the socket or in some cases their residual limb, their amputation was had to, had to be performed at such a high level that a socket is just not an option.
And so this really allows us to treat these patients and get them to the level where they can use one of these incredible prosthetic limbs now. And. When you talk to these patients that have gone from a socket to Osseo integration, it's incredible to hear them talk about it. The things that Dr. Melton has already mentioned about Osseo perception.
I mean, if you watch a patient with a socket walk frequently, they're glancing at their feet constantly because they've learned their lesson. They've, they've had a fall there. Their leg will spin on them. They'll trip on something with osteo integration. The, the risk is less than because they.
Proprioception. They regained the ability to feel certain things in their foot and in their shoe that over time as they get used to it, they can start predicting when they're on carpet or grass or pavement. Um, other things that they really like about it, it takes even a very, very experienced socket user, at least 30 seconds or a minute or so to just take their leg on and off or to make adjustments and frequently it takes even longer.
To do because there's several layers to the system and with osteo integration, the connectors that connect the legs take seconds. I mean, it's, it's as simple as, uh, clicking in to a pair of slip-on shoes or clicking into a ski boot or something like that. And so the time that it takes them to do it as in.
Insignificant. And so they'll put their leg next to their bed in the middle of the night. And if they need to go to use the restroom, they'll pop their leg on and go to the restroom. Whereas before that was unheard of, they'd have to get their crutches or a Walker or spend the time to put their prosthetic on.
And so this is for sure, a quality of life, procedure, and. The quality of life improvements that we're offering are significant. It's not just simply like potentially walking with a little less pain or something. It's potentially the difference in walking versus sitting in a wheelchair. And so when we've identified the right patient, who's motivated, who's struggling with their limb loss and struggling with their socket mounted, prosthesis.
This is the. A fantastic option for them to discuss. And it's not only improving their, their gait, their function, it's improving their psychology along with that as well. And so it's, it's an extremely rewarding procedure and, and, uh, very, very fun to be part of a group of people who, you know, working so hard to push the boundaries and to advance the care that people are reading.
Caitlin Whyte (Host): Well, as we wrap up here, back to you, Dr. Mountain, is there anything else you would like us to know about oui or your role within the.
Danielle Melton, MD (Guest): Sure. So one of the things that I have really watched, not only with this program, but just over the course of the last 15 years of doing this is the advances that we've made with caring for people with limb loss.
And, you know, I like to term it optimizing limbs or trying to restore limbs. So it's not just about procedures, like osteo integration. There's other procedures that we have that I think are available. That when you put all of that together, we're getting one step closer to being able to have patients feel like they can restore their limbs.
And so while prosthetic devices can only get. So far, I think when you combine procedures like osteo integration and some of the other ones where we talk about sensory feedback, that's where this technology is going. And that is really where being a part of a group that has the experience and the ability to perform these state of the art procedures is really kind of the future of limb loss.
And those of us that care for people with this it's, it's an exciting time.
David Doherty, MD (Guest): Absolutely. I would like to definitely reiterate that it is very much a team approach. And I come from a family of a lot of business people and teachers and no doctors or anything like that. So I kind of, my experience in medicine has been one of an academic experience. I really enjoy being in the. The university of Texas Memorial Hermann systems, where we are a tertiary referral center, we get the opportunity to work with residents, fellows, medical students.
And I truly feel like it's my calling and the position that I'm in right now to advance the field, not just not just see patients and take care of patients, but to truly try and make a difference and advance the field. And for. For many kind of coincidental reasons. My path has been led down this osteo integration path, and it's very exciting to me and I completely recognize the opportunity.
I have to really make a difference. And it's a very exciting thing for me, because I've really been wanting to be part of a group in a system that is not just looking to try and do as many procedures as we can. Make as much money and things like that as we can, but to really, really advance the scientific and medical aspect of the field and hopefully benefit the next generation of people.
And so, yes, being part of a multi-disciplinary group is something that I've always really envisioned for my career. And it's exciting to be part. This group, because we really are, I think, in this country, on the cutting edge and on the cusp of really advancing the field. So I'm very appreciative of the support of Memorial Hermann university of Texas and here, and just fun place to be a part of it.
Well,
Caitlin Whyte (Host): we so appreciate both of you taking the time to join us today and share this important information for more visit Memorial herman.org/ dash implant. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This is advance the podcast series from Memorial Hermann I'm Katelyn.
Caitlin Whyte (Host): Advancing health, personalizing care at Memorial Hermann. This is our mission. This podcast shares the science and stories behind those efforts. Today we're interviewing Dr. David Doherty and Dr. Danielle Melton to discuss how osseointegration is restoring freedom to amputees by offering better quality of life through improved function and mobility.
Dr. Melton, start us off here. Just what is osteointegration?
Danielle Melton, MD (Guest): That's a great question. So, osseointegration was a term that actually has been around for about 30 years and it started more in the dental implant realm, but it's really moved more into amputation and limb loss. Another term that we use is direct skeletal attachment. And the idea is that using an implant that goes directly into a long bone and then having a trans continuous connector allows amputees the ability to have a prosthesis without a socket. And a socket is really the most challenging interface or fit or difficulty that people have with wearing a prosthesis. So, for many people, osseointegration allows them to be able to use the prosthesis, whereas before they may not have been able to do that.
Host: And Dr. Doherty is osseointegration a common procedure for amputees? I mean just how many healthcare systems
Caitlin Whyte (Host): offer osseointegration procedures?
David Doherty, MD (Guest): So OHI is not a common procedure for amputees. It's becoming more popular and becoming more visible in the orthopedic and limb loss community. However, the first procedure for an amputee was performed in 1990 by Dr. RIckard Brånemark. And since that time, he has been perfecting his technique and implant system and making the improvements that were necessary and were became evident as he started to hone the procedure down. And now we finally entered into the phase of this procedure where we have an implant system that is FDA approved for this indication. So, I think that in the future osseointegration will become a much more approachable and much more mainstream treatment for these patients as.
Talking right now, there's only a handful of centers in the country and I'm being a little vague about that because it's tough to nail down exactly how many centers are doing this. There are some surgeons that have done one and really have a plan to continue the program, but in terms of main centers where the focus is on osseointegration and providing osseointegration for amputees, I think that the Memorial Herman Center is, is unique in it, in the sense that we have our University of Texas physicians who are focused on both the rehab and the surgical procedure.
And so we are able to offer them a comprehensive care package for their amputee osseointegration needs. Not only is the surgery incredibly important to complex and unique, but the rehabilitation needs for these patients are incredibly unique as well. And so one doesn't work without the other and that's sometimes the barrier for places in the country that do not have as robust of a system, that has the expertise in the physicians and also in the hospital system to provide this level of care for patients. So, it's so unique and complex. So, not many people are performing the procedure at this time, but part of our goal is to demonstrate it's effectiveness and to demonstrate the improvements in patient and quality of life that they experienced. So we can bring this more to the forefront and, and hopefully continue to improve the.
Host: Now what type of patient makes a good candidate? We'll go back to you. Dr. Melton.
Dr. Melton: There's lots of people that have limb loss and, and we really do need to be fairly selective in who is appropriate for osseointegration. There are some risks involved with a procedure like this. One of the significant ones that has been a concern for a delay perhaps in ensuring that this goes through the proper FDA approval channels, is the risk for infection. And so in selecting the right patient, you want to make sure that they meet certain criteria when selecting a patient that we want to make sure that they're skeletally mature.
So usually it's someone of adult age, at least skeletally. And then to make sure that they don't have other significant comorbidities or risk factors that might prevent them from being a good candidate for this. As Dr. Doherty mentioned, one of the things that we really strive to do in our team approach is to be able to screen patients appropriately.
We have an osseointegration clinic once a month. During that process, we evaluate patients who might be good candidates. Typically that starts with people who are having, currently having difficulty with their prosthesis. A lot of times having to do difficulties with their sockets fit. So in this clinic, we have obviously Dr. Doherty as a surgeon, myself as the rehabilitation doctor, and then a physical therapist with expertise in limb loss and in particular, osseointegration and the rehab that goes behind that. And then we might also look at patient's history and other medical issues that might complicate anything, but we can answer a lot of the questions that patients have in this setting with a lot of the experts that are in the room.
We take some time to go through imaging, to see if their limb is appropriate. And do other medical workup that would allow us to see if they had any other, the risk factors that I mentioned. So, I think that that's one of the advantages to looking at this from a comprehensive team approach. And one of the things that we really strive to improve upon here.
Host: Sticking with you. Let's talk about that team. What is your role in the Ojai program at Memorial Hermann?
Dr. Melton: As I mentioned, I'm the Limb Loss Director for the Amputee Program at TIRR, which is the Rehab Hospital in Houston. And I have for the last 15 years had an Amputee Clinic. So I have a pretty large patient population where I can work with amputees and fit them with prosthetic devices and really kind of look at them from continuity of care issue.
Long-term my role in the osseo integration. Piece of this is to really maybe have the direct initial contact with patients to the, whether or not they are appropriate for us to integration and then refer them into the Osseo integration group for that team approach. Dr. Doherty and I work closely together as he is, as the surgeon, and then the rehab piece, following the surgical procedure, whether it's, prehabilitation leading up to that in between the two different stages.
And then long-term rehab care post-op to start with a gait training and then just following them throughout their lifetime. And Dr. Doherty, tell
Caitlin Whyte (Host): us, please also about your role.
David Doherty, MD (Guest): So for my role in the Osseo integration program, I work closely with the rehab team. And as Dr. Melton was mentioning, she has a closer relationship with a larger amputee population and through her work for more traditional amputee care, she.
Developed a relationship with a lot of these people and has developed a reputation also that draws people in seeking kind of the best rehabilitation care for, for their limb loss and in working with them when they are starting to have difficulty with their socket mounted prostheses, and are struggling to obtain the ideal.
For attaching their prosthetic leg to their residual limb. They start to ask her if there are other options. And fortunately, during my residency at the university of Texas here in Houston, I had the opportunity to go and spend about three months doing a mini fellowship with one of the pioneers of Osseo integration.
So I learned the techniques and. The ins and outs of certain implant systems and things of that nature, and then performed further training and joint replacement, which is actually, there's a lot of corollaries to Osseo integration because just to back up a little bit, the term Osseo integration, Has been existence in orthopedics for 60 or 70 years now.
And it is a descriptive term of the bone physically growing into metal and becoming biologically fixed to metal. So the surgery, Osseo integration relies on the principle of Osseo integration of bone growing into metal to do it. And that's kind of where the name comes from. So. Taking all of these little pieces of training that I've had through my career.
I found myself in the unique position where I had a big clinical interest in bringing Osseo integration and making it more visible to Texas and to Houston and the university of Texas and Memorial Hermann were very supportive and they helped me and Dr. Melton start to. Lay the groundwork for creating an osteo integration program.
And so not only have we both been very involved with the kind of behind the scenes process of making sure the implant system is approved in the Memorial Hermann system, making sure the billing folks have weighed in and gotten some financial considerations taken care of. That's sort of my background role in Osseo integration and the, I guess, nuts and bolts of how I fit into the clinical aspect of it is I, I perform the surgeries.
And so once we have a patient that is motivated and has met the indications for surgery, the process is about a six month process. We see them in clinic. We bring them to surgery. Perform the first stage, three months later, we perform the second stage and then they enter their more dedicated rehabilitation phase.
So throughout that whole process, I'm present doing the procedure, making sure that the postoperative care is coordinated and making sure that the patient's surgical needs are met. And this. Obviously done with my usual surgical team that is works at a, at a place that is regarded in the region as essentially the top place to get orthopedic elective cases done, particularly with things like joint replacement or complex orthopedic procedures.
So we have a team of surgical technologists, anesthesiologists, and rehabilitation specialists all within the hospital system. Perfectly trained to take care of these patients needs with essentially just a little bit of extra education from Dr. Melton and myself about the unique needs of the Osseo integration patients.
So it's a, it's a really great, it's been really fun to watch it all come together. Not only my training. That I spent a lot of extra time doing unique things to give myself the expertise to perform these procedures, but also just seeing all of the behind the scenes work that the professionals at Memorial Hermann and university of Texas have, have put into this to make it all happen for these patients.
Caitlin Whyte (Host): Where would you say that OHI fits into a patient's journey? Dr. Melton and what is so
Danielle Melton, MD (Guest): rewarding? Yeah, that's a really great question. I'm glad you asked it. You know, I've had an opportunity now to, to probably have more than 30 patients. Who've had osteo integration in my practice, whether they've gone abroad to have it, or whether they've had it at our facility since we've started doing it within the last year.
When you talk to patients about this, they will tell you, this is life-changing. They will say that their quality of life is significantly improved. They're able to wear their prosthesis longer. They're have a significant improvement in their quality of life and the amount of time that it takes to put on their prosthesis or take it off.
They're able to walk longer distances. They're able to feel the ground underneath them. That's a term that we. Coined that's called Osseo perception. And for, for many of them, they'll also say that they have a decreased risk of falling because they can feel what they're stepping on. And so, yeah, it's exciting to watch and to see them get excited about this and, you know, for, for us, it's, it's having the ability to really participate in that process to get them to a better place.
Caitlin Whyte (Host): Dr. Doherty. Tell us about the benefits of Ojai, as opposed to the more common prosthetics and procedure
David Doherty, MD (Guest): options. I see the benefits of osteo integration and, and some of my most memorable moments in, in my career have been watching some of these patients walk on their prosthetic limbs after spending time in either a wheelchair on crutches.
Potentially have lost hope in, in their quality of life. So those have been some of the most rewarding patients I can see. I mean, just watching people walk again is, is a incredibly moving thing to behold, but I readily admit that osteo integration is not for every patient. So there are a lot of limb loss patients out there.
Do really well with sockets and they do really well with their prosthetic limbs and that's fantastic for them. And so when we enter into this subset of patients that are struggling with their prosthetic fit or their inability to, you know, keep their prosthesis on for extended periods of time or they're having falls with it once.
We're able to start talking to those patients. It's pretty, pretty fun to start talking to them and explaining to them that there might be a better way to have their prosthetic limb attached to them and the kind of excitement or the hope that that gives them sometimes is, is what this patient really needed psychologically to really get motivated, to, um, continue on, to see.
Possibility that they could, you know, return to their work or their job, or be the type of mother or father to their kids that they want to be. And, and things like that. So some of the benefits of osteo integration are that we do not use the socket. And so specifically talking about this. You know, it's a common story that a lot of the Osseo integration or rehabilitation specialists talk about that these prosthetic limbs that we have now have, I mean, essentially.
Military jet technology and on they've got microchips and they've got robotic processors in them and things like that. But then we attach them to patient's limbs in the same way that they were attaching prosthetic limbs in the ancient Greek or Roman times. There's hieroglyphics that show people with sockets, with fake legs attached to them.
And so it's a. Very much the weak link in the system at this point. So if you are having challenges with sockets, this completely eliminates the socket. You don't have to, uh, try and obtain a suction fit or try and jam your leg into a bucket essentially. And why. Our technology with sockets has improved.
There are still definitely patients that no matter what we do, they are not going to be very well served by a socket. And these are patients that have large amounts of scarring on their limb, or they might have residual tissue that is preventing them from utilizing the socket or in some cases their residual limb, their amputation was had to, had to be performed at such a high level that a socket is just not an option.
And so this really allows us to treat these patients and get them to the level where they can use one of these incredible prosthetic limbs now. And. When you talk to these patients that have gone from a socket to Osseo integration, it's incredible to hear them talk about it. The things that Dr. Melton has already mentioned about Osseo perception.
I mean, if you watch a patient with a socket walk frequently, they're glancing at their feet constantly because they've learned their lesson. They've, they've had a fall there. Their leg will spin on them. They'll trip on something with osteo integration. The, the risk is less than because they.
Proprioception. They regained the ability to feel certain things in their foot and in their shoe that over time as they get used to it, they can start predicting when they're on carpet or grass or pavement. Um, other things that they really like about it, it takes even a very, very experienced socket user, at least 30 seconds or a minute or so to just take their leg on and off or to make adjustments and frequently it takes even longer.
To do because there's several layers to the system and with osteo integration, the connectors that connect the legs take seconds. I mean, it's, it's as simple as, uh, clicking in to a pair of slip-on shoes or clicking into a ski boot or something like that. And so the time that it takes them to do it as in.
Insignificant. And so they'll put their leg next to their bed in the middle of the night. And if they need to go to use the restroom, they'll pop their leg on and go to the restroom. Whereas before that was unheard of, they'd have to get their crutches or a Walker or spend the time to put their prosthetic on.
And so this is for sure, a quality of life, procedure, and. The quality of life improvements that we're offering are significant. It's not just simply like potentially walking with a little less pain or something. It's potentially the difference in walking versus sitting in a wheelchair. And so when we've identified the right patient, who's motivated, who's struggling with their limb loss and struggling with their socket mounted, prosthesis.
This is the. A fantastic option for them to discuss. And it's not only improving their, their gait, their function, it's improving their psychology along with that as well. And so it's, it's an extremely rewarding procedure and, and, uh, very, very fun to be part of a group of people who, you know, working so hard to push the boundaries and to advance the care that people are reading.
Caitlin Whyte (Host): Well, as we wrap up here, back to you, Dr. Mountain, is there anything else you would like us to know about oui or your role within the.
Danielle Melton, MD (Guest): Sure. So one of the things that I have really watched, not only with this program, but just over the course of the last 15 years of doing this is the advances that we've made with caring for people with limb loss.
And, you know, I like to term it optimizing limbs or trying to restore limbs. So it's not just about procedures, like osteo integration. There's other procedures that we have that I think are available. That when you put all of that together, we're getting one step closer to being able to have patients feel like they can restore their limbs.
And so while prosthetic devices can only get. So far, I think when you combine procedures like osteo integration and some of the other ones where we talk about sensory feedback, that's where this technology is going. And that is really where being a part of a group that has the experience and the ability to perform these state of the art procedures is really kind of the future of limb loss.
And those of us that care for people with this it's, it's an exciting time.
David Doherty, MD (Guest): Absolutely. I would like to definitely reiterate that it is very much a team approach. And I come from a family of a lot of business people and teachers and no doctors or anything like that. So I kind of, my experience in medicine has been one of an academic experience. I really enjoy being in the. The university of Texas Memorial Hermann systems, where we are a tertiary referral center, we get the opportunity to work with residents, fellows, medical students.
And I truly feel like it's my calling and the position that I'm in right now to advance the field, not just not just see patients and take care of patients, but to truly try and make a difference and advance the field. And for. For many kind of coincidental reasons. My path has been led down this osteo integration path, and it's very exciting to me and I completely recognize the opportunity.
I have to really make a difference. And it's a very exciting thing for me, because I've really been wanting to be part of a group in a system that is not just looking to try and do as many procedures as we can. Make as much money and things like that as we can, but to really, really advance the scientific and medical aspect of the field and hopefully benefit the next generation of people.
And so, yes, being part of a multi-disciplinary group is something that I've always really envisioned for my career. And it's exciting to be part. This group, because we really are, I think, in this country, on the cutting edge and on the cusp of really advancing the field. So I'm very appreciative of the support of Memorial Hermann university of Texas and here, and just fun place to be a part of it.
Well,
Caitlin Whyte (Host): we so appreciate both of you taking the time to join us today and share this important information for more visit Memorial herman.org/ dash implant. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This is advance the podcast series from Memorial Hermann I'm Katelyn.