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Limb Reconstruction


Limb reconstruction surgery is an advanced and intricate branch of orthopaedic surgery designed to restore anatomy, stability, function, and appearance to limbs that have been severely affected by trauma, infections, tumours, congenital deformities, or unsuccessful prior surgeries.

This surgical approach involves a combination of orthopaedic techniques, including:

  • Bone Realignment and Lengthening: Adjusting bone positioning and length.
  • Bone Grafting: Transplanting bone tissue to support healing.
  • External and Internal Fixation: Using devices to stabilize bones during healing.
  • Bone and Joint Replacement: Replacing damaged bone or joint components.

In addition to these techniques, soft tissue procedures such as tendon transfers or skin and muscle flaps are employed to address complex limb conditions.

The primary objective of limb reconstruction surgery is to enhance the patient’s quality of life by improving mobility and independence. The ultimate goal is to enable patients to lead more fulfilling and active lives. This comprehensive approach to limb restoration helps individuals regain their abilities and confidence in their daily activities.

If you are facing limb-related challenges, consulting with a skilled orthopaedic surgeon can provide valuable insights into the potential treatment options available to you. They will work with you to develop a personalised treatment plan that best suits your needs and helps you achieve your desired outcomes.

If you wish to schedule an appointment, please don’t hesitate to call Macquarie Hospital at 02 9809 2111

Limb Reconstruction at Macquarie University Hospital

The Macquarie University Hospital, under the guidance of Professor Al Muderis, specialises in advanced limb reconstruction procedures. These include osseointegration, limb lengthening, limb deformity correction, limb deficiency and weakness correction, complex joint replacement, revision arthroplasty, bone and joint infection treatment, and complex foot and ankle surgeries, including ankle joint replacement for arthritis. The hospital has also established a dedicated Limb Reconstruction centre, aiming to be a leading facility in Australasia for complex and innovative limb surgeries.

Meet the Team

The Limb Reconstruction Centre brings together a group of skilled orthopaedic surgeons,
including Professor Munjed Al Muderis, Associate Professor Kevin Tetsworth, Dr. Razvan Stoita, Dr. Tim O’Carrigan, and Dr. Mustafa Alttahir. Working collaboratively under a robust Multidisciplinary Team (MDT) model, the surgeons adopt a unique approach to patient care.

The MDT Approach to Treatment and Diagnosis:

At the Limb Reconstruction Centre, we believe in a collaborative approach to patient care. All five surgeons consult simultaneously, ensuring comprehensive assessments and diagnoses. This approach extends to the operating room, where two surgeons work together on each patient.

Our patients often have complex, longstanding conditions, and many have exhausted other treatment options. We strive to offer innovative, tailored, and minimally invasive surgical solutions, aiming for the best possible outcomes.

Comprehensive Support
To ensure comprehensive support throughout the treatment journey, the Limb Reconstruction Centre collaborates with various medical specialists. These include spinal, plastic, and vascular surgeons from MQ Health, infectious disease consultants, psychologists, physicians, pain specialists, physiotherapists, rehabilitation experts, and a limb reconstruction-trained Clinical Nurse Consultant to provide patient education and close support to the patient during their treatment journey.

Below, we provide a brief overview of some of the surgeries available at Macquarie University Hospital:


Osseointegration is a groundbreaking surgical procedure that involves the direct integration of prosthetic implants with the patient’s bone, allowing for improved mobility and functionality. The Centre is renowned for its pioneering work in osseointegration in Australia, with Professor Al Muderis having performed this procedure since 2009. This groundbreaking technique has helped thousands of war veterans with limb loss and individuals with congenital limb deformities regain the ability to walk.

The team continues to push the boundaries of innovation, having successfully integrated mind-controlled, or ‘bionic’, limbs through the implantation of electrodes in osseointegrated limbs thanks to collaboration with engineers from Macquarie University.

Limb lengthening
For limb lengthening procedures, the Centre employs a range of techniques, including the traditional Illizarov technique, computerised hexapod framing, and advanced intramedullary magnetic lengthening devices such as the Precice® Bone Transport System, an all-internal system that was utilised in the first Australian limb lengthening surgery of its kind.

Ankle joint replacement surgery
The Limb Reconstruction Centre also specialises in ankle joint replacement, employing preoperative 3D scanning and custom treatments to ensure highly accurate and successful procedures.

Complex Foot and Ankle Surgeries

Doctor Tim O’Carrigan and Dr. Mustafa Alttahir conduct complex minimally invasive foot and ankle surgeries, utilising external fixation and percutaneous minimal incision surgery to correct foot deformities, as well as performing total ankle replacements for severe rheumatoid arthritis cases.

Indications and Contraindications for Limb Reconstruction Surgery

Indications for Limb Reconstruction Surgery:

  • Severe trauma: High-energy trauma resulting from traffic accidents or falls from heights can cause complex fractures, soft tissue damage, and bone loss, necessitating acute reconstruction.
  • Nonunion, Malunion: In some cases, fractures may heal in abnormal positions (malunion) or fail to heal at all (nonunion), requiring reconstruction surgery to restore alignment or promote bone healing.
  • Bone Infections (Osteomyelitis): Chronic bone infections necessitate surgical debridement to eradicate the infection, followed by reconstruction to address bone loss.
  • Congenital and Developmental Limb Deformities: Patients born with limb abnormalities or conditions causing progressive musculoskeletal deterioration, such as bone and joint deformities, limb length discrepancies, and neuromuscular imbalance, may require corrective surgery to promote normal growth and improve function.
  • Tumour Resection: Reconstruction is needed to restore bone integrity and limb function after wide resection of bone tumours in limb-sparing surgery.
  • Failed previous surgeries: In cases of suboptimal outcomes from previous surgeries, revision and reconstruction surgery may be necessary.
  • Joint Destruction or Instability: Reconstructive procedures can restore and stabilise joint function when joints are unstable or damaged.


Contraindications for Limb Reconstruction Surgery:

Although limb reconstruction surgery offers significant benefits, it is an exhaustive and demanding process, and for some patients, the risks may outweigh the benefits. Contraindications include:

  • Poor general health: Patients with complex medical conditions may face a high risk of complications during and after the surgery.
  • Active infection: Any active infection should be eradicated before considering reconstruction surgery.
  • Neurological or Cognitive Disorders: Conditions severely affecting central and peripheral nerve function and sensation may limit the reconstructive options.
  • Advanced Joint Destruction: Patients with extensive joint damage may benefit from reconstruction surgery only if combined with joint replacement.
  • Unrealistic Expectations: There are biological limits to reconstruction, and patients with unrealistic expectations may need further guidance to understand the achievable outcomes.

Surgical Options for Limb Reconstruction

Limb reconstruction procedures are not limited to a single technique. Typically, a combination of different approaches is required, and multiple surgeries may be necessary over several months.

Limb Reconstruction Surgery can involve the following techniques:

  • Osteotomy: This involves cutting the bone to realign the segment and restore the limb’s mechanical axis.
  • Internal fixation: Nails, rods, screws, and plates are used to stabilise bone fragments.
  • External fixation: Pins and wires stabilise bone fragments or joints using an external frame. The frame allows for gradual correction of large deformities around bones or joints and causes less soft tissue injury.
  • Bone Lengthening or Bone Transport: Used for limb length discrepancies or segmental bone loss, this technique gradually lengthens the remaining bone with an external fixator or a motorised nail to achieve the desired size.
  • Bone Grafting: This involves “borrowing” bone from one site and placing it in another. Grafts may come from the patient’s own body (autograft) or from a donor (allograft). Bone grafts are used to fill bone defects, stimulate healing, and promote bone regeneration.
  • Joint Replacement: In cases where joints are severely damaged and not amenable to reconstructive surgery, prosthetic implants are used to restore function.
  • Soft Tissue Reconstruction: When the soft tissues enveloping the limb are damaged, a skin or muscle flap may be required to provide adequate coverage.
  • Tendon Surgery: This is performed in cases of muscle imbalance or deficiency. Procedures such as tendon release or lengthening correct joint contractures, while tendon transfers restore joint function.

Personalised Treatment

It is essential to remember that each patient’s situation is unique, and the choice of surgical options will depend on the nature of the limb condition and the patient’s specific requirements. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons, and rehabilitation specialists is often necessary to achieve the best outcomes in limb reconstruction surgery.

Factors for Success

The success of limb reconstruction surgery depends on careful patient assessment, meticulous planning, skilled execution of the chosen surgical procedures, and close follow-up and rehabilitation. With advancements in surgical techniques and orthopaedic instrumentation, we can safely perform increasingly complex procedures, enhancing function and improving the patient’s quality of life.