Ronald W. Hillock, MD Provides Landmark Surgery for Amputee

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Inside the exercise room of Matt Smith Physical Therapy, Elizabeth Bailey-Smith is moving, albeit a little stiffly, in a circle around the large workout area with encouragement from physical therapist Ed Dolegowski. It was her first walk on two legs in a year.

Bailey-Smith’s long journey to medical history started with a pain in her right leg. Doctors discovered a lump behind her right knee and found she’d developed chondrosarcoma, a cancer that affects the bones and joints. If she opted to simply remove the cancer, her chances were high that it could return. An amputation was needed to erase the disease. It’s been a few months since Bailey-Smith has been discharged from physical therapy and she wears her state-of-the-art prosthetic leg all the time. A cane helps, but for the most part, it’s all her.

As the first reported person in the U.S. to receive an osteointegration implant for transfemoral amputation, Bailey-Smith’s progress is significant. In May 2013, Ronald Hillock amputated Bailey-Smith’s right leg from just above the knee down. At the same time, he placed a titanium alloy rod implant in her femur, which allowed for a stable and secure attachment so forces can be transmitted from Bailey-Smith’s hip and thigh musculature to a prosthesis.

At Hillock’s practice in Nevada Orthopedic & Spine Center, he is focused on the diagnosis and treatment of musculoskeletal disease and adult reconstruction. With Bailey-Smith, Hillock was prepared to start a medical process he’d never performed before, in the name of making headway in the field of prosthetics. Once Bailey-Smith’s body became used to the implanted rod, she was ready to begin using a pylon that extends down directly from her bone. This direct-to-bone attachment allows the osteointegration implant to give patients more movement akin to the natural body, through a direct energy transfer to the device, whereas traditional prosthetics can sometimes be clunky or make the wearer feel separate from his or her piece.

During her time at Matt Smith Physical Therapy, Bailey-Smith’s sessions began with Bailey-Smith attaching her prosthetic to the permanent rod that juts out from her leg. “This is a much different situation than I’ve ever experienced. There’s a huge benefit to this, because there’s no socket and she has total control. It’s going to be phenomenal,” Dolegowski, the physical therapist, said last May. “Can you see my goosebumps?” Today, Dolegowski says he’s confident and happy that Bailey-Smith is able to walk and negotiate stairs, inclines and declines safely. He adds that she has a high level of functionality and he’s never had a person with an above-knee amputation feel more comfortable standing. “I was hopeful because the whole prosthesis is connected to her skeleton. It’s not just an extension of her leg. It is her leg because it’s attached. When she puts weight on her foot, she feels it because it’s connected to her body,” Dolegowski says.

And she does, in fact, feel her prosthetic foot. In her first week wearing the complete prosthetic, Bailey-Smith said she felt a sensation in her new foot when it grazed a wall in her home. “It’s becoming a part of me,” Bailey-Smith says. “I feel all the little bumps and sensation is definitely in play.”

To be clear, Bailey-Smith was an ideal candidate for this. She says she wasn’t going to accept permanent amputation without prosthesis and has a strong desire to return to her career as a critical care nurse. She’s a nonsmoker who’s in great shape and doesn’t have to take medications for anything other than the amputation. She also received extensive counseling before undergoing this process. Prior to receiving the osteointegration implant, Bailey-Smith was counseled by experienced prosthatists about the anticipated function from a conventional suction suspension system prosthetic and wasn’t satisfied. She then received extensive counseling about the expected form and function from the osteointegration device prior to beginning her journey.

With the guidance of Dolegowski and the Matt Smith Physical Therapy staff, Bailey-Smith executes her steps more naturally than someone using a traditional prosthetic. Her gait is also assisted by a programmable micoprocessor in her knee, which allows Bailey-Smith to mimic her natural gait so both legs move in time with each other. Bailey-Smith is able to set the mini computer in her knee to match her natural steps as often as needed, as she gains strength or wears different shoes.

To gain strength and become used to all the ways her new leg moves, Bailey-Smith exercises three times each day in her home with assistance from her husband, Dwayne. Although she’s been discharged, Bailey-Smith says she still has back pain, which she thinks stems from an alignment problem. When she’s standing for long periods, such as when she’s cooking, the pain becomes worse. Because of that, she says she wants to return to Matt Smith Physical Therapy to have the staff help her figure out what’s causing the pain and give her tools to combat the issue. She also says she needs to learn more about how to make the adjustments on her programmable knee. As she grows stronger, more adjustments will have to be made to match her new stride. She’d also like to learn to allow for the changes that need to be made when she wears shoes with a heel.

“When you know what you’re doing, it’s not difficult at all. But, if you don’t make the correct adjustments I could be leaning forward like the Leaning Tower of Pisa. It’s amazing how much a little fraction of an inch can make in making these adjustments,” Bailey-Smith says. Even with the issues that come with learning to use her new prosthetic, Bailey-Smith says she’s happy with her progress. “Last year this time I was pretty much a mess mentally and physically because I was not able to emulate. Last December I was using my walker with one foot,” Bailey-Smith says.

Since completing her surgery, Hillock has published four case reports on Bailey-Smith’s recovery in a scientific peer-reviewed publication, the Reconstructive Review, the journal of the Joint Implant Surgery & Research Foundation. Hillock also has made several presentations at scientific meetings, including a recent one at the University of Nevada School of Medicine’s annex in Las Vegas. “I would declare Elizabeth at this point at a stable and static state. I’m trying to talk her into going back to work now,” Hillock says. “That’s where we sit with her.”

Looking ahead for the device, Hillock and his cohorts are working on the 1.5 iteration of the osteointegration implant, based on information from Bailey-Smith’s experience. Three people are in the design process for an updated model. In February, Hillock was expected to perform his second osteointegration procedure. Hillock’s results and processes are constantly reviewed by an independent board of ethics, but since the prosthetics are custom, they don’t have to have Food and Drug Administration approval, they just have to be disclosed in detail to the FDA. The organization can, however, pull the plug on Hillock’s project at any time. Looking ahead, Hillock already has permission to perform the procedure on nine more patients, after which he said he hopes to get that extended to 10 more.

Dolegowski says that the success Bailey-Smith has had with her implant is extremely innovative in the physical therapy world. “It’s one of those things you look at as a therapist and say ‘Why haven’t we done this sooner?’ Dr. Hillock and the engineers, what they went through, for the United States, it’s game changing,” Dolegowski says. “It wasn’t easy. They really got it done. It’s extreme innovation and it’s truly amazing.” In terms of Bailey-Smith’s back pain, Dolegowski says she’s experiencing it because she can feel her new leg’s effects throughout her entire body. “I loved the experience of working with Elizabeth and what this innovation can do for patients. It’s a world of difference for people and will allow them to attain a real high level of function,” he adds. As she becomes stronger and stronger, Bailey-Smith has said she’s most looking forward to bicycling and walking her dog, Macy Gray. She’s not yet at the point where she can ride a bike, but she sees it happening. “I’m becoming steadier on my feet, and I’m more acclimated to my prosthetic device,” she says. Bailey-Smith says she also wants to visit a specialist she met at a medical conference with Hillock who can help manipulate her back and teach her some tricks of the trade to get out the kinks at home. “To experience a diagnosis of cancer and amputation does not mean that your life is over. It has shown me how to be more patient with myself and how to adapt to a situation and be creative in getting the things done that you need to do,” Bailey-Smith says.