THE MOST INCREDIBLE ORTHOPEDIST YOU’LL EVER READ ABOUT (Orthopedics This Week)
“Hasta la vista, baby.”
The day that Munjed Al Muderis, M.D. fled his native Iraq he held in his heart a vision of a future à la The Terminator. Dr. Al Muderis, now an internationally acclaimed surgeon and developer of the Osseointegration Prosthetic Limb, was on the run from Saddam Hussein’s government.
He told OTW, “I was happy in Iraq. I had always dreamt of being a surgeon. At the age of 12 I saw The Terminatorand I was transfixed by the medical possibilities of technology. ‘I want to make those limbs for people!’ I thought. Witnessing the agony of so many Iraqi veterans only strengthened my resolve to go in this direction.”
Then one day he arrived at work only to be asked to perform an outrageous, revolting task. “I was a resident at Baghdad University Hospital. One day Saddam’s Republican Guards descended upon the hospital with three busloads of military defectors. The surgical team was instructed to surgically remove the ears of each of these men. When the chief surgeon protested, he was dragged outside and killed. Then the soldiers asked if there were any other complaints.”
“I managed to escape the room and hid in the female restroom for five hours. It was five hours of hellish shock. All of a sudden my life was turning from that of a comfortable surgical resident to one of a fugitive.”
“I fled to Jordan, where I falsified a passport and had the good fortune to have someone remove my name from the security system for a brief period of time. If the border guard had suspected anything I would have been shot on the spot.”
Just a Refugee…
From there Dr. Al Muderis went to Malaysia, then Indonesia, and finally took a boat to Christmas Island in Australia—a boat packed with 165 other refugees. “We ended up in a detention center in Western Australia where we were stripped of our names and assigned numbers. I was number 982; the experience was hellish.”
Years later, Dr. Al Muderis is comfortably ensconced in Australia. He is now sought after—you might say “courted”—by the military establishment because he’s got the talent and technology they need. But back in those days he was just trying to make it to safety. “The guards put me in isolation for 40 days because they were trying to break me; knowing that this was their purpose made me determined to survive. During the time I was locked in this windowless 1.5meter/2.5meter cell I did have access to an anatomy book and was able to pass the primary surgical fellowship exam immediately after I left the detention center.”
…Headed for Destiny
Fast forward to the present. Munjed Al Muderis has taken a technology pioneered in Germany and Sweden, and began implementing his childhood vision of helping amputees. “In contrast to traditional prosthesis, the OPL Osseointegration Prosthetic Limb gives amputees a natural loading of the femur and hip joint, something that helps them avoid bone atrophy and eventual osteoporosis. I simplified the original design and approach, and cut the rehabilitation period from 18 to 3 months only. The Swedes were doing the surgery in two stages; the patient has to wait six to nine months before the second stage of the procedure, during which time he or she is in a wheelchair. This new way is one operation, then three days after the patient start learning how to walk again.”
“The initial design of the German implant was made of chrome cobalt alloy material (I changed it to titanium which is more biocompatible). The initial implant had a macroporous spongy surface structure, which allows good bony penetration, but doesn’t provide initial stability due to its cylindrical structure so they added an external bracket to the implant to provide initial stability. This created a major problem with infection as the bracket caused an area where there was major friction with the soft tissue, which lead to frequent infections.”
Improving the Design to Address Muscle Groups
“I changed the design to make the proximal half of the implant containing sharp fins to enable cutting grooves in the bone. This provides initial rotational stability and the distal part of the new implant has a rough surface coating (plasma sprayed) allowing good bony ingrowth; the distal part of the implant is flared to provide an initial axial stability.
“Another feature in the new implant design in case of a short residual femur is the capability of the implant to place a lag screw across the femoral neck to provide for further stability and to protect against fracture of the neck of femur.”
As for how he improved the surgical technique, Dr. Al Muderis stated, “Reduction of the soft tissue at the distal end of the stump dramatically reduces the movement and friction with the implant this reduces the chance of infection. The management of the skin opening where the implant protrudes externally is done in a way that the skin is sutured to the bone so as to minimize or even eliminate any contact between the soft tissue and the implant. This technique reduces infection dramatically. The neuromas that contribute to the phantom limb pain and sensation are appropriately addressed and excised to reduce the symptoms caused by them.”
“The muscle groups were not addressed and often they used to be left as they were post amputation. I improved on the surgical technique by regrouping the muscles around the bone residual end in a more anatomical and functional fashion to give the best chance of the patient to operate the leg as close as possible to pre injury state.”
Making Prosthetics Osseointegrative
At this point, there are a mere four surgeons worldwide performing Dr. Al Muderis’ osseointegration procedure. The British Ministry of Defence is hoping to change that. “They are spending nearly $3,000,000 on trials involving 20 amputees. I have trained five British surgeons; we will perform the surgeries and monitor those 20 cases for two years. We are in the process of setting up similar projects in Canada and Houston, Texas.”
Several Americans have traveled to Australia to undergo osseointegration. Fred Hernandez did just that three years ago. He told OTW, “I was a senior in high school when I fell asleep at the wheel and ended up under a semi truck. When I had a traditional prosthesis I had significant tension in my back and lots of headaches from all the tightness. Because the socket pushed out and up on one side. Now my stance is square and I no longer experience tension in my back or headaches.”
“For 28 of the 30 years that I have been an amputee I used traditional socket technology. My aging skin was breaking down more and more; I was uncomfortable and in pain. As an above knee amputee you bear your weight on the inner groin and the ischial bone. Walking around like that means that it constantly rubs and the skin breaks down, resulting in sores. Osseointegration has meant an enormous leap in my quality of life.”
Dr. Al Muderis, reflecting on his proudest moment as an orthopedic surgeon, noted, “My first osseointegration surgery on a British soldier who had lost both of his legs above the knee. The day he walked into his yard at home after this surgery his wife and five year old son were peering out the window. The patient’s wife said, ‘Look. Here comes Daddy.’ The boy replied, ‘That’s not Daddy. Daddy doesn’t walk.”
A sharp mind—accompanied by a big heart—has taken Dr. Al Muderis far. These days, he is the ambassador for the Australian Red Cross. “I help keep refugee issues in the press by promoting the Red Cross via all aspects of media. I also participate in my professional capacity as an orthopaedic surgeon in Red Cross activities where needed in disaster zones. In addition, I speak to local audiences in Australia to raise awareness about the worldwide refugee crisis.”
Clearly, he will never forget how he reached this point in his life. Asked what he would like people to know about refugees, he stated, “Just like all of humanity you have human beings amongst the refugees who are ‘the good, the bad, and the ugly.’ They are, naturally, a slice of the community. Listen…people wouldn’t be refugees if things were OK where they were because the risks involved in leaving home are horrific. They deserve a second chance.”
And then, sometimes, they can pay it forward.