Mrs Deanne Ward is 79 years old and spent ten years living in South Africa with her late husband. Following the birth of her second child, she was diagnosed with rheumatoid arthritis aged 28. Sadly, childbirth can be a trigger for women with this condition. Mrs Ward began suffering long before she ever received proper treatment.
Rheumatoid arthritis is an autoimmune disease, this means that Mrs Ward’s immune system began attacking the cells that lined her joints instead of fighting the disease. In Mrs Ward’s case the disease was particularly aggressive and advanced rapidly in the days before the modern disease-modifying drugs were available resulting in a form which is less common now but then was known as Arthritis Mutilans such that all Mrs Ward’s joints were affected and by the early 2000’s she had undergone procedures for new knees, hips, elbows and eventually shoulders.
Talking about the early years of her diagnosis, Mrs Ward said: “The arthritis is particularly challenging, you lose your appetite and become extremely tired during a flare-up. It was difficult for my children growing up, they couldn’t understand why I was so ill and did not cuddle them as I would have wanted and was being short-tempered.”
She went on to say, “Though I tried to never let it stop me doing the things I wanted to, I never lost faith in the idea that I could get better through joint replacements, there were and are other people in the world who suffer with conditions far worse than mine.”
However, as Mrs Ward’s condition continued to deteriorate, she began to experience problems with the shoulder joint replacements. A rheumatologist she was under recommended that she go and see Mr Ian Bayley, Consultant Orthopaedic Shoulder Surgeon. “The rheumatologist had seen pretty much every stage of my condition and following a series of x-rays noticed that a problem had developed in my shoulder. She recommended Mr Bayley because, to use her words, ‘seems to take on the challenges.’ My shoulder had kept dislocating, so I was optimistic that whatever Mr Bayley might have planned would help stop this from happening.”
“That’s when the real journey began.”
Mrs Ward first met Mr Bayley in Harley Street; she had previously had all her treatment done privately. Unfortunately, because of the complexity of Mrs Ward’s medical history, she was unable to obtain medical insurance.
Mr Bayley examined Mrs Ward’s medical history and did a series of detailed tests to better understand the issues affecting her shoulder. Commenting on that first consultation with Mr Bayley, Mrs Ward said, “He was so compassionate, I was not treated as a shoulder problem, I was treated as a person. He took his time to explain what he thought was wrong and how he intended to try and ease the pain.”
In August 2020, Mrs Ward had her first operation with Mr Bayley at The Clementine Churchill Hospital in Harrow, North London. The operation lasted several hours and consisted of the removal of the existing failing prosthesis followed by a complex reconstruction of the shoulder with a bespoke CADCAM prosthesis designed and made in partnership with the biomedical engineers of Stanmore implants worldwide specifically for the circumstances of Mrs Ward’s shoulder.
Mr Bayley described the complexity of the first operation he carried out on Mrs Ward, he said: “At presentation, the previously implanted prosthesis had not only destroyed all the glenoid bone but had also migrated upwards penetrating completely through the clavicle to lie next to the Brachial Plexus nerves and jeopardising the overlying skin of the nape of the neck. Such extensive bone destruction made rescue with an off-the-shelf prosthesis impossible, and the only solution was to combine with our engineering colleagues in SIW to design a bespoke uncemented CADCAM prosthesis with a scapular spine outrigger to bring the shoulder joint back down to its proper position.
“This was combined with bone allograft to recreate secure scapular bone stock and durable biological prosthesis fixation. Having achieved solid osseointegration (direct structural and functional connection between living bone and the surface of a load-bearing artificial implant), the scapular outrigger was then removed.”
He went on to say: “Thus, the Meccano, that was the simplest part of Mrs Ward’s journey. Subsequent multiple procedures were required to stabilise the artificial joint because of repeated dislocations and also to secure healing of the extensive surgical incisions through skin made paper thin and fragile by the underlying disease and medications.”
After a four-day stay at the hospital, where Mrs Ward was cared for by Sister Kulvinder and the staff of Epping Ward, she was able to go home. “The whole experience was made easier by the kind and caring nurses and ward staff who made such an effort to get to know me. Mr Bayley would come and see me to make sure I wasn’t in pain.”
Sadly, when Mrs Ward returned home, she began experiencing problems with her shoulder again.
“I went to open a kitchen draws and the joint popped out. Once it was reset, the problem sustained. My mobility and ability to perform even basic tasks was inhibited. Despite this, I never lost hope that even with this setback, we could get the outcome I wanted.”
When asked how, despite the persistent setbacks, she was able to remain so optimistic, Mrs Ward said: “I was still walking and there were others a lot worse off than me. I have had the condition for so long that I don’t dwell on the negatives as much anymore. Mr Bayley was doing everything he could, and I trusted him.”
Mr Bayley described in detail the challenge of Mrs Ward condition, he said: “Mrs. Wards shoulder represented end stage disorganisation (the destruction of organic tissue) in fiercely independent woman. Despite advanced destruction of every joint in her body over decades, including her hands, she was determined to maintain that independence.
“The severity of Mrs. Ward’s form of arthritis occurs less commonly these days since the advent of disease modifying medication. However, there is a modern form of the extensive destruction illustrated by Mrs. Ward’s shoulders which will become increasingly common. As the volumes of primary total shoulder replacements increase and in ever younger patients so the volumes of multiply revised and increasingly bone deficient shoulders requiring CADCAM bespoke types of devices will also increase together with the type of outstanding levels of care provided to Mrs. Ward by Clementine Churchill Hospital staff.
“Her journey was therefore more a marathon than a sprint but for obvious reasons if Mrs. Ward’s independence was to be secured failure was not an option. There is no doubt that without the close-knit teamwork of the front line and back-room staff at the Clementine Churchill Hospital successful completion of the journey would not have been remotely possible.”
At one stage, it was believed Mrs Ward was allergic to penicillin, this made tackling the infection in Mrs Ward’s joint harder. Each time the infection returned another drain was needed to clear the build-up of fluid.
Following a three-week stay at the Clementine Churchill Hospital, Mrs Ward began to get better and “touch wood we seem to be better”, she said.
“I don’t think about it all that much anymore. I do have days of being down, but I have learnt to be patient. Mr Bayley has been wonderful, and I am closer to my goal of being more mobile again. My only complaint is that the Clementine Churchill isn’t closer to where I live.”
Mrs Ward lives in Kingston, South London and travels to the hospital in Harrow regularly to receive her care.
Following each procedure with Mr Bayley, Mrs Ward passed a milestone she had set for herself, “I couldn’t wait for all the joint replacement surgeries, it was an opportunity to get on with my life and after having this condition for so long any chance I get to help ease the pain I take with open arms.”
Mrs Ward will continue to see Mr Bayley to continue the work he has started. The hope is that these will only be minor procedures to assist with the long-term management of Mrs Ward’s arthritis.
When asked where she wanted to be in the future, Mrs Ward said, “The hope is to stay as independent and mobile as possible, for as long as possible. Walking is still difficult but through all the work I have had done by Mr Bayley and the team at the hospital, I am getting stronger. I am confident that I can get where I want to be soon.”