Southmead surgeons carry out first knee reconstruction using donor bone and tissue

Thursday, 27 April 2017

You may have seen our surgeons on BBC's The One Show last night talking about an operation using donor bone and tissue to help reconstruct a patient's knee. Here's more about the pioneering procedure:

Surgeons at Southmead Hospital performed a half knee transplant on a patient using donor bone and tissue.

In what was believed to be the first of its kind, the team - made up of orthopaedic surgeons, plastic surgeons and trauma surgeons – used half of the knee, part of the thighbone and part of the lower leg bone from the NHS Tissue Bank to piece patient Stuart Jotham’s knee back together.

Stuart Jotham who had his knee reconstructed using donor bone and tissue at Southmead HospitalThe 32-year-old damaged his right knee after coming off his motorbike in April 2011 and was seen at the regional Major Trauma Centre, which was then based at Frenchay Hospital.

The incident caused Stuart to lose the side of his knee along with the skin, bone and ligaments. Surgeons worked to save his leg carrying out three operations and using a large flap of skin and muscle as part of the initial repair.

Stuart was referred to North Bristol NHS Trust Orthopaedic Consultant James Murray several months after the accident because he had been left without any stability in his right leg, but because the injury had led to the loss of approximately a third of his knee, there was no bone to support a reconstruction.

Mr Murray felt the best solution was to use donor bone from NHS Blood and Transplant’s Tissue Bank in Liverpool in order to support further reconstruction of Stuart’s knee in the future.

“Allografts with donor bone are something we use in orthopaedics to fill in bits that are missing but Stuart had lost bone, joint surface and ligaments and what we decided to do was to use a whole knee and cut out the bits that we needed,” Mr Murray said.
“We used half the knee on the tibia, a quarter on the femur and the proximal fibula along with associated ligaments and cartilage.
“When I contacted the NHS Tissue Bank in Liverpool they said this had never been done before and this was the first.”

In order to carry out the procedure the team had to wait for a donor knee that was a good size match for Stuart.

A CT scan was taken of Stuart’s good knee and a mirror image model was made by Professor Justin Cobb’s team at Imperial College London to help understand the 3D structure of the missing bone from Stuart's knee when planning his reconstruction.  The NHS Tissue Bank was given the dimensions so that they could locate an appropriate donor knee. And in November 2014 Stuart was informed that a suitable donor knee had been found, with the surgery being carried out in February 2015.

James Murray was joined by Plastic Surgeon Thomas Wright and Trauma and Orthopaedics Surgeon Michael Kelly to carry out the procedure. It is an ongoing process for Stuart who had the most recent operation on his knee six weeks ago. 

“I was excited about having operation, but I always knew it was going to be a hard, long journey,” Stuart said.
“The latest operation was the important thing and I am hopeful that it will take my knee to a good enough level so that I can carry on doing the things I want to do with a bit more certainty. I want people to know how important it is for people to be donors.”

Stu Jotham proposing to his girlfriend after his operation

Following surgery Stuart was able to get down on one knee to propose to his girlfriend in Iceland – and get back up without her help.

“It was my goal to get down on one knee under the Northern Lights and I had been planning it for a year and a half,” he said.

The couple have now married and Stuart has been continuing to test his knee as much as possible. Mr Murray added: “Stuart is doing really well at this stage. He is such a positive patient who has coped with his injury and treatment incredibly well and it is still in progress.”