From left: Matt Hughes, Clinical Services Director at Dorset Orthopaedic, Moose Baxter, Midlands Clinic Manager for Dorset Orthopaedic, and Relimb surgeons Norbert Kang and Alex Woollard

The country’s first dedicated Osseointegration and Targeted Muscle Reinnervation (TMR) surgery and rehabilitation service for amputees has been launched in London.

The service, to be run by Dorset Orthopaedic and Relimb – part of the private patients’ unit (PPU) based at the Royal Free London NHS Foundation Trust — will allow amputees, who wish to live a life free from socket-related problems or nerve-related pain, to access these innovative surgical procedures and follow-up rehabilitation in one package of care.

Relimb surgeons Norbert Kang and Alex Woollard, who work in the PPU at the Royal Free London NHS Foundation Trust in Hampstead will perform the surgical procedures, while Dorset Orthopaedic (which has clinics in Ringwood and Burton-On-Trent) will provide follow-up rehabilitation and support.

The launch of the service took place at the Royal College of Physicians, with Norbert and Alex explaining the intricacies of their ground-breaking surgical procedures alongside a number of inspiring patient testimonies.

Alex Paterson at the launch

Delegates, which comprised of patients considering the surgery, case managers and solicitors, heard from Caroline Rutley-Frayne, who had osseointegration surgery on her leg in Australia and now enjoys hikes up to 20km a day, Alex Paterson, who is the UK’s first upper limb amputee to have both TMR and osseointegration surgeries, and former Olympic judo competitor Jo Horton, who had TMR surgery to rid herself of phantom limb pain.

Matthew Hughes, Clinical Services Director at Dorset Orthopaedic, said: “The event was a huge success and we have had excellent feedback from all parties. We’re delighted to be a part of this pioneering new partnership with Relimb and bringing these incredible treatments to the UK.”

TMR is a complex surgical procedure which can give patients a realistic chance of complete relief from neuroma pain while simultaneously improving phantom limb pain. For upper limb amputees, TMR surgery also gives them the means to control far more complex, multi-articulated, prostheses — operating in much the same way a person would use a normal limb — instead of a standard prosthesis.

The surgery involves identifying the free nerve ends in a patient’s stump and connecting them to residual muscles within, or close to, the amputation site. Electrical signals travelling down the nerves are then amplified by the muscles, allowing them to achieve outcomes associated with this surgery.

Osseointegration surgery involves the insertion of a metal implant into the residual bone of a stump. Its unique properties help it to fuse with the bone, creating a solid and secure fixation point for a prosthesis. Currently, most osseointegration patients are lower limb amputees but it is suitable for almost all lower and upper limb amputees.

Norbert commented: “We’re incredibly excited to be the first in the UK to offer this combination of revolutionary procedures from one surgical unit. It is a great honour for us and couldn’t have happened without the combined efforts of many teams.

“We’re delighted to be partnering with Dorset Orthopaedic to provide this service, which will ensure our patients experience a seamless pathway of care.”

Relimb was set up in 2018 to provide an amputee reconstruction service for patients based in the UK and abroad. The Relimb team comprises two plastic surgeons, Norbert Kang and Alex Woollard, who work in close partnership with Professor Munjed Al-Muderis.

Norbert has been performing TMR surgery since 2013 and was trained in this technique by Professor Oskar Aszmann from Vienna. He has been performing OI surgery since 2005 and has been trained in the techniques by many surgeons.

Alex is an NHS consultant plastic surgeon at the Royal Free London NHS Foundation Trust and The Royal National Orthopaedic Hospital in Stanmore. He specialises in nerve regeneration and leads the facial palsy and sarcoma reconstruction service at the Royal Free London NHS Foundation Trust. As part of his interest in nerve regeneration, he joined forces with Norbert in 2016 performing TMR surgery.

In 2018, both Norbert and Alex travelled to Iraq with Prof Al Muderis to do a fellowship in osseointegration and formed Relimb shortly afterwards.

Established in 1989, Dorset Orthopaedic is an independent provider of prosthetic, orthotic, silicone and rehabilitation services.

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