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TwitThisAn Expandable Bionic Bone
Ashley’s parents, Donna and Floyd Garrett, didn’t know what to expect when Michael Neel, MD, an orthopedic surgeon at St. Jude, pointed to the X-ray and told them there was a good chance the strange bump that seemed to appear overnight on their little girl’s leg was cancer. Ashley could barely grasp the implication of the doctor’s words. “We don’t know what this is right now, but whatever it is, Ashley, we’re going to take good care of you,” Dr. Neel said. Scans and a biopsy indicated that the egg-size tumor had not spread. But Ashley would still need three months of chemotherapy to kill any wandering cells and to shrink the tumor before Dr. Neel could remove it.Dr. Neel said it was very lucky that Ashley’s leg, severely weakened from the tumor, hadn’t fractured during gymnastics or a recent family ski trip. The mass would have ruptured, making the tumor grow larger. Donna Garrett was even more shocked when Dr. Neel said he’d have to remove the upper third of Ashley’s shinbone. “We were prepared to do whatever it took to save her life,” Donna recalls, “but I was concerned about how this would affect gymnastics and things she loves to do. How was she going to be a normal little girl?”
To get a safe margin around the tumor, Dr. Neel would also have to remove the growth plate at the base of Ashley’s knee. This plate, the source of new bone cells, was responsible for about 40 percent of the growth of her leg. Ashley still had five more years and five inches of growth left. So the surgeon planned to use a new implant called the Repiphysis—a bionic bone of sorts that expands when activated by an electromagnetic device. It was a huge improvement over the previous generation of kids’ prostheses, which were lengthened manually by reopening the surgical incision and turning a screw to expand the leg.
The Repiphysis would require just one surgery and several noninvasive lengthening sessions every year or so. After an initial recovery period, including months of physical therapy, Ashley would be able to swim, ride a bike—even do some cheerleading.
On August 26, 2002, after four rounds of chemo, Ashley lay on a gurney in a pre-op room, surrounded by her family and pastor. They prayed and told Ashley angels were watching over her before heading to the waiting room to sit out the six-hour surgery.
Dr. Neel made an incision on the inside of Ashley’s left leg, from above the knee joint to her ankle. He and St. Jude’s director of surgery, Bhaskar Rao, MD, carefully separated the muscles and blood vessels before sawing through her shinbone six inches above her ankle and lifting the diseased bone out of its socket. Then he replaced it with the three sections of the Repiphysis. First he attached a titanium-alloy rod to the remaining shinbone. Next he anchored the other end of the implant to the bottom of Ashley’s thighbone. Then he attached the midsection containing the expanding part and joined the pieces together by inserting at the knee a pin that acts like a hinge.
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