Seven years after losing her leg, Angelena Dolezar is getting back on her feet again – thanks to generous community support.

Angelena Dolezar can already do things she couldn’t do before, like walk without her leg falling off, but she’s not quite where she wants to be just yet.

It will take several more months to recover from the surgery that connected her new prosthetic leg to her thigh bone – a procedure called osseointegration.

“Full recovery is a year … until your implant is ossified into your bone,” says Dolezar.

“It’s grueling right now, but I know, in the long term, it will be much better.”

Dolezar, 35, is the first person to receive osseointegration in Alberta and one of two patients who have undergone the surgery since the program launched at the University of Alberta Hospital earlier this year.

Funding for the procedure came from the community through the University Hospital Foundation’s Festival of Trees, a long-standing source of community generosity that has generated more than $22million in support for nearly every corner of care at the hospital site.

“Everyone knows how generous Edmontonians are,” says Dolezar. “I just never thought I’d be the recipient of it.”

Life-changing injury

Healthy and active her entire life, Dolezar’s houseboating trip with friends was supposed to be a fun few days in beautiful British Columbia.

“I motioned for the driver to slow down and I was thrown into the water. I knew my leg was hurt, but I never thought it
was as bad as it was.”

After a month in hospital, doctors determined that Dolezar’s injured leg would have to be amputated. “Knowing that you’re going into a surgery that’s going to change your body forever is really hard,” she recalls.

Surgeons amputated her leg above the knee. For the next several years, Dolezar tried her best to cope with a traditional prosthetic leg, even competing in the sport of sitting volleyball on the Canadian Paralympic team.

But her prosthetic leg was an endless source of pain and frustration. “I can’t really do a lot of the things that I used to do,” Dolezar said before receiving osseointegration. “It’s just like, my [prosthetic] leg falls off all the time and it’s so frustrating.”

It’s a situation Dr. Jacqueline Hebert has seen many times in her work as a rehabilitation physician. “There are a number of patients who have an amputation and they do OK with regular treatment,” says Hebert. “But there is a significant percentage of people that don’t do well with the traditional treatment. We try so many different things and they’re just not successful. For those people, their quality of life is very poor. Their life is constantly revolving around what’s going on with their leg and how their prosthesis is fitting.”

Like dental implants for legs

Dolezar’s young age and the constant problems she had with traditional prostheses made her a good candidate for osseointegration, the most advanced procedure for attaching prosthetics in the world.

Defined as the fusion of bone into titanium – osseointegration has been around for many years. It’s used in procedures like dental implants. Titanium has special properties that allow bone to grow in and around it. But this new application of osseointegration is groundbreaking in the way it allows amputees to use prosthetic limbs.

“The traditional way of attaching a regular prosthesis to the limb is by putting this hard plastic shell around the limb and squeezing the soft tissue. You can imagine putting a large band around your thigh and rolling it around, you can’t control the
bone,” Hebert says.

The beauty of osseointegration is that it puts the connection back between the ground and the patient’s skeleton.

“For a lot of patients, when they actually step on the prosthesis, it’s a very different feeling,” says Hebert. “It’s like they’re stepping on their own foot again. They say, ‘I feel like it’s coming right through my bone now, I can feel my foot, I can feel when I hit the ground, I can feel the vibration when I swing my leg.’” Hebert and Dr. Robert Stiegelmar, an orthopedic surgeon at the University of Alberta Hospital, worked for five years to bring the surgery to Edmonton. When organizers of the 2019 Festival of Trees, UHF’s largest fundraising event of the year, took up osseointegration as the official cause, the doctors became more hopeful than ever that Dolezar, and others, would get the surgery that would put them on their feet again.

“It was crucial to have the involvement and support of the Festival of Trees to bring this program to reality,” says Hebert

In recent years, Festival sponsors, led by Reza Nasseri’s Landmark Homes, individual donors and tens of thousands of ticket buyers, have contributed millions to bring such groundbreaking innovations asCanada’s first Stroke Ambulance and Gamma Knife, the most advanced non-invasive brain surgery in the world, to the University of Alberta Hospital. “It was crucial to have the involvement and support of the Festival of Trees to bring this program to reality,” says Hebert. Before the festival was over, Dolezar’s surgery date was booked.

Brighter future for amputees

Hebert and her team see about 100 new amputees every year from the Edmonton area and northern Alberta. The vast majority
are due to diabetes and other vascular causes, while others are due to trauma, cancer, infections or previous injuries that didn’t heal.

About 30 per cent of them have had leg amputations above the knee. But only a portion of those – Hebert estimates five new patients per year – would be candidates for osseointegration.

That’s because candidates for the procedure need to be young and relatively healthy with good bone stock, for the best chances of success.

“We are starting very conservatively and only choosing the absolute best ideal candidates at this point because we want to ensure that we’re getting the appropriate improvements in their health and quality of life,” she says.

But the program may one day expand, says Hebert. She notes that surgeons in Australia, where more than 400 osseointegration surgeries have been performed, have done it on some diabetes- and vascular-related amputations. Other centres have also done osseointegration on below-the-knee and arm amputations.

“In Edmonton, we’ve been starting the procedure on people who’ve lost the leg above the knee, in the thigh bone, because that’s a very limiting amputation,” she says.

For now, the multidisciplinary team is gaining experience and collecting data. Funding raised through the Festival of Trees is allowing it to keep a close eye on patient outcomes.

“The Festival of Trees funds that were raised have allowed us to build an extra infrastructure to collect more data than we would normally collect on a patient going through a procedure,” Hebert says. “So we’ll have our own body of evidence.
The best way to introduce a new program is to carefully monitor the first cases going through.”

Just as the osseointegration program got going, the COVID-19 pandemic caused delays. Hebert is looking forward to when the program can resume and help more amputees improve their quality of life.

As Dolezar progresses along the road to recovery, she’s thankful she was able to receive this leading edge surgery here at home.

“I’m grateful that the donors supported the project … and I’m grateful for the future,” she says. “I’m excited to live a life where my leg isn’t the focus of my life … I can create an identity that’s me again, with my leg having just been something that happened to me – not the focus and the central component of my life.”