Dec 17, 2012

Robotic Surgery Saves a British Soldier from Amputation

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The British soldier, who suffered a severe leg injury while serving in Afghanistan, can walk again thanks to a world-first operation and custom-fit joint


Captain James Murly-Gotto faced the prospect of amputation after being hit by machine gun fire during a 10-day mission in Helmand province.
One bullet passed straight through the flesh of his left leg, but the other tore through the bones in his right. The inside of his knee was destroyed, and two major leg bones were splintered.
However, he sought out a world-leading surgeon who helped create replacement parts that - in the soldier’s words - “slot in like flat-pack furniture”.
The operation at the King Edward VII’s Hospital Sister Agnes in London involved marrying two technologies for the first time.
Initially, he underwent 3D scanning to create tailor-made computer designed replacement parts.
Then Professor Justin Cobb, a leading orthopaedic surgeon, used a robotic arm to remove just the right amount of bone - and not a speck more.
The operation was such a success that Capt Murly-Gotto has been able to take to the golf course once again, with the help of a buggy, and even ride a bike.
“My wife has bought me a new one for Christmas,” he said. “I can’t wait.”
That will crown a dramatic reversal of fortune for the Scots Guard, who almost died from blood loss when hit outside Lashkar Gah in February 2010.
“It looked like a shark had taken a large bite,” he said.
He was only saved by a comrade, Lance Sergeant David Walker, who ran across open ground under fire to patch him up.
Sadly, Lance Sergeant Walker died in action the following week. He was posthumously awarded the Queen’s Commendation for Bravery.
A helicopter whisked Capt Murly-Gotto to Camp Bastion where a trauma team saved his leg. He was put on an overnight flight to Britain and by lunchtime the next day he was in Birmingham's Selly Oak Hospital. However, his trials were not over.
He said: “The knee was ‘absolutely knackered’, that’s what the doctors called it. They were 50-50 about whether or not to take it off.
“But I always thought, ‘I’ll give it a go with what I’ve got’. It’s a very final thing, to have a leg removed.”
He spent 10 months in a leg frame, waiting for the shin bone to knit together. All he could do was hobble 300 yards to the post box and back.
“It was a very difficult time,” he admitted.
A full knee replacement was a possibility, but he would have needed a revision operation every eight years, raising questions over his long-term mobility.
He did some digging, and came across Professor Cobb, an expert in tailor-made prosthetics.
Last December Prof Cobb operated using a Stanmore Sculptor, featuring a robotic arm that enabled him to prepare the bone surface to precisely match the implant.
The result is a ‘composite’ knee that is almost as well aligned as a natural one.
Prof Cobb said: “Exactly a year ago I asked James in front of 300 medical students, ‘What do you want to be able to do?’ He said, ‘I just want to be able to do my own shopping.’
“For someone like him to have such poverty of aspiration was terrible.
“To see him so much improved is wonderful.”
After a year’s outpatient rehabilitation at King Edward VII, including intensive physiotherapy, Capt Murly-Gotto is now firmly on the mend.
“I thought I would be still be hobbling around, but not at all. I’ve got a slight limp but that’s it,” he said.
“I’m able to play golf and even ride a bike. To move at pace again is amazing.”
 

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