'Life-changing procedure': Ont. amputee calls on province to cover osseointegration
Avis Favaro and Elizabeth St. Philip, CTVNews.ca
Published Sunday, April 28, 2019 10:00PM EDT
Last Updated Monday, April 29, 2019 8:45AM EDT
The only outward sign that Brock Fryday was involved in a horrible accident is his slight limp.
In 1996, the Paisley, Ont., man was fishing off a bridge when a car veered off the road and struck him. Fryday fell into the water and his wound became infected, leaving doctors no choice but to amputate his right leg above the knee.
“Had (the infection) got to my hip, I would not have made it,” Fryday said.
Since then, Fryday has relied on a full prosthetic leg to walk, but it often causes him to suffer from skin breakdown issues and leaves him in agony.
Fryday cannot wear a modern suction fit socket and so he uses a more old-fashioned belt and strap to hold the prosthesis in place. The socket rubs again the skin on his stump near his groin, making it painful to sit and can lead to cysts that sometimes become infected and need to be surgically removed. Occasionally he is forced to miss work.
Between 34 per cent to 63 per cent of socket prosthesis users have chronic skin problems and pain resulting from friction between the residual limb and the prosthesis.
Since 2017, Fryday has been petitioning Ontario’s health plan to pay for a new procedure called “osseointegration” that promises to help people like him walk more normally and to lessen pain.
Osseointegration involves the insertion of a titanium rod into a leg stump. The rod protrudes through the skin and latches on to a mechanical leg.
According to a 2018 report from Orthotics Prosthetics Canada, the implants “have the potential to fundamentally improve the quality of life of amputees and (to) shift the field of Canadian prosthetics.”
Demand for the implants is growing. So far about 25 people have received the implants. Most travelled to Australia where the current system was pioneered. The implant surgery and rehab costs over $100,000 and patients themselves have paid for it . In a few cases, provinces offered some support for the out of country operation.
But Now a Quebec clinic is offering osseointegration at a much lower cost about $44,000.
Dr. Robert E. Turcotte is the orthopedic surgeon at the McGill University Health Centre who believes that for some patients, the implant offers a way to pay less, and improved mobility.
“I think it is a life-changing procedure,” said Dr. Turcotte. “It makes the quality of life of a patient better.”
His patients either pay for it themselves or have accident insurance that covers the procedure. And the province of Quebec has decided that osseointegration is ready for wider use, as it prepares to pay for some 50 provincial amputees who are suitable to get the implants.
Fryday first applied to get it in Australia and then requested the procedure in Quebec. All of his requests have been denied, and despite having appeals rule in his favour, representatives from the Ontario Health Insurance plan (OHIP) indicate they will continue to oppose payment.
It's an illustration of the complexity facing patients who need novel medical procedures. Provinces grapple with the decision whether to pay for them. Where a patient lives, determines if they will get it at no personal cost.
Canadian Agency for Drugs and Technologies in Health (CADTH) issued a report in February saying there was "low quality evidence" on the rates of infection, and long-term follow-up
Health Quality Ontario also recommended against provincial overage in a draft document.
Osseointegration it writes “may improve functional outcomes.” However "there are still concerns about “the frequency and severity of serious adverse events” and uncertainty about whether “anticipated benefits outweigh the risks.”
Dr. Turcotte says while there are questions - the long-term effects will take time to measure. In the meantime, the data is showing implants are better for patients for whom standard prosthetics are hindering their quality of life.
“All the rehab doctors across the country and the world are very convinced that this is a good operation for amputees and for selected amputees but for this committee to come out with such a decision was really disappointing,” he said.
As for Fryday, he says he can no longer afford the money or time to continue to fight OHIP for out of province coverage. His focus now is to raise or borrow from family to pay for the implant himself in Montreal.
“It’s incredibly hard to save that money and try to pay your bills,” he said. “Especially when the device you are walking on now limits you to how much you can work to make that money to pay for the surgery.”
Fryday is aware if he lived just one province away, his story would be different – a sobering reality of the Canadian health care system.