Once the amputations and infection risk have passed, though, the real work for patients begins, and so does the remarkable innovation coming from battlefield medicine. “In terms of the long-term prognosis, we’ve come a long way in terms of technological advances and manufacturing of limbs and prosthetics,” Galhotra says. Instead of previous single-hinge-point knees, for example, he describes relatively new “microprocessor knees,” which have motors that can act on the different types of loading the knee sustains while walking, thereby “normalizing” the gait. “Before, if someone had come to us with both above-knee amputations, the prognosis for that individual was very bleak, because it takes very high energy for that person to walk, given that they would have two prosthetic limbs with hinges they had to mechanically control by shifting their body weight,” Galhotra says. “Now with the advancement in the knee joints, those people can walk for longer periods of time and possibly keep out of a wheelchair long-term.”
Another innovation has been construction of “exoskeletons” of sorts for those who lose part of their pelvis. Galhotra described a 20-year-old soldier who lost his right hip joint and the left half of his pelvis. “You’re not left with a lot to work with,” he says of such a situations: a person missing a pelvis cannot even sit down without tipping over. In the past the soldier likely would not have walked again. “Today, that individual is up and walking with bilateral prosthesis, but it took a lot of innovation,” Galhotra says. “It’s those kind of catastrophic injuries that led to the innovation, know-how and problem-solving to get these individuals back to being able to function in society.”
In the process of developing better prosthesis, Galhotra says that physical therapists have also learned the importance of preventing complications arising from reduced mobility throughout the recovery phase. “Old medicine used to say ‘rest is best and let it heal,’” he says. “New medicine says you need the rest and recovery, but just long enough to be able to accept the prosthesis.” Prolonging rest can decondition the body in terms of cardiovascular health and can risk letting the muscles shorten, making it painful and difficult to straighten the joint. “It’s sort of a battle between comfort and maintaining function,” Galhotra says.
Despite the advances, researchers still have much to learn to improve treatment. The Walter Reed paper noted that advances in bone-regeneration technologies have hit a ceiling, but promising avenues remain in finding improved methods of nerve reconstruction.
Even if that technology becomes a reality, however, patients will need one thing most of all: time.” The recovery phase is unfortunately very long-term,” Galhotra says. “Individuals with these injuries survive and have excellent outcomes—they can go back to playing basketball and participating in fulfilling life activities, whether it be returning to work or family life—but it takes a long time to get there.”