When the air ambulance rushed Jim Ashworth-Beaumont to King’s College Hospital in southeast London, doctors didn’t think he would survive. He had been cycling home when a lorry driver turning left at traffic lights failed to see him beside the trailer. The vehicle’s wheels ripped open his torso like a tin can, puncturing his lungs, splitting his liver, and tearing off his right arm. Weeks after the July 2020 accident, Ashworth-Beaumont asked to see a photo of his severed limb, taken by a doctor as it lay beside him in the hospital. “My hand didn’t look too bad,” he recalls. “It was almost like it was waving goodbye to me.”
Ashworth-Beaumont, a former Royal Marine from Edinburgh known for his fitness and cheerful nature, spent six weeks in a medically induced coma as surgeons worked to save his shattered body. But as he lay on the road waiting for paramedics, his only thought was that he was dying—he had no time to dwell on the cruel irony of his situation.
Years earlier, after leaving the Marines, Ashworth-Beaumont—now 59—had studied prosthetics and orthotics at the University of Strathclyde in Glasgow. These fields focus on helping patients with mobility and pain management through devices like prosthetic limbs and braces. He later worked as an orthotist at London’s Royal National Orthopaedic Hospital, training prosthetists and writing research papers. “Now I was the patient,” he says.
I first meet Ashworth-Beaumont in Greenwich Park, near the south London home he shares with his wife, Keri, a solicitor he met on a night out in 2002. It’s early summer 2024, nearly four years after the accident in nearby Catford. He speaks softly, his smile faltering only when he reflects on how far he’s come. “Without Keri,” he admits, “I think I would have just sat in a corner and wasted away.”
Initially, his missing arm was the least of his worries for plastic surgeon Edmund Fitzgerald O’Connor, who was focused on treating his severe abdominal injuries. But by chance, the 47-year-old surgeon had a special interest in limb loss and had been searching for the right candidate for an innovative procedure he wanted to offer amputees.
Osseointegration (OI), or direct skeletal fixation, is a modern way to attach prosthetic limbs. Instead of relying on a traditional socket fitted over the stump—a method used for centuries—the prosthesis connects to a titanium implant inserted directly into the bone. Attaching a prosthetic is as simple as changing a camera lens.
OI eliminates the irritation and infections caused by socket friction, improves movement and control, and enhances proprioception—the body’s natural sense of limb position. “It feels like I’ve got my own leg back,” says Hanneke Mooij, a Dutch secretary who suffered for decades with ill-fitting sockets before receiving an implant.
Advances in electronic prosthetics now allow surgeons to connect them directly to the nervous system, bringing bionic limbs closer to reality. But OI’s progress hasn’t been smooth. Some patients have experienced cracked implants or painful infections around the surgical site. The procedure is also costly, making it difficult for many amputees to access cutting-edge prosthetics.Basic Prosthetics Care
Fitzgerald O’Connor believes many of the 25,000 patients treated by the NHS prosthetics service each year could benefit from osseointegration (OI). When we first met, the National Institute for Health and Care Excellence (NICE) was reviewing the procedure to determine its suitability for NHS funding.
“It’s heartbreaking,” O’Connor says. “When you perform 15 to 20 amputations a year and see patients struggling with recurring stump problems, knowing there’s a better option they can’t access is frustrating.”
He had been assembling a team to offer OI privately when King’s College Hospital approached him. He was looking for a resilient, healthy patient who could help promote the procedure. If Ashworth-Beaumont could fund his treatment, his professional insight into recovering from traumatic amputation would be an added advantage.
“You couldn’t have invented a better candidate,” O’Connor admits. “The idea crossed my mind the day he arrived, but I wouldn’t mention it until I was sure he’d survive.”
### The Accidental Discovery Behind OI
Osseointegration was discovered by chance. In the 1950s, Swedish scientist Per-Ingvar Brånemark inserted titanium optical devices into rabbits’ legs to study bone healing. After the experiment, he found the metal had fused with the bone—defying the belief that the body rejects foreign objects.
This led Brånemark, who passed away in 2014, to develop titanium dental implants in the 1980s, eliminating the need for dentures. Curious if the same principle could support larger devices, he and his son Rickard—an engineer training as an orthopedic surgeon—designed a bigger implant. In 1990, they fitted a woman who had lost her legs in a tram accident with two above-knee implants.
The procedure was groundbreaking, evoking sci-fi imagery like Star Wars or The Six Million Dollar Man. But it was also controversial.
“I remember giving a lecture in the U.S. in the late ’90s when a senior professor stood up and said, ‘Only an idiot would think this could work,’” recalls Rickard Brånemark, now 65, who founded Integrum, the first OI company, in 1998. Still, a few pioneering surgeons saw its potential, and soon, Integrum had competitors.
### A Rival Approach
In Sydney, Iraqi-born surgeon Munjed Al Muderis—who fled Saddam Hussein’s regime after refusing to amputate deserters’ ears—developed his own OI device, first implanted in 2008. His method involves hammering rather than screwing the implant into the bone. He claims over 2,000 patients have received his implants, while Brånemark reports more than 700 Integrum devices installed.
Al Muderis, 52, is OI’s most vocal advocate. He now offers the procedure to diabetic patients, who make up the majority of leg amputations—a group often rejected by other surgeons due to concerns about rehabilitation challenges.
“There’s a huge opportunity for this technology to replace traditional socket prosthetics,” Al Muderis says during a Zoom call as he changes out of his scrubs.
He shares the case of a seven-year-old Iraqi orphan who lost an arm in a dog attack while sleeping. Adopted by a wealthy Chinese family, the boy will soon receive an implant that will need replacing as he grows. Unlike other surgeons, Al Muderis believes children can be suitable candidates despite requiring additional surgeries. For leg amputees, he argues, the benefits outweigh the risks.
“I see it almost as a duty to explore the possibilities,” he says.OI helps children walk again faster. “It’s all about balance,” he explains, noting that children’s prosthetic sockets need replacing much more frequently than OI implants.
The boy will also have a procedure called targeted muscle reinnervation (TMR), which redirects nerves from the amputated limb. This can ease pain in the residual limb, where severed nerves sometimes form painful, tumor-like growths called neuromas. Even more remarkably, TMR can allow amputees to control prosthetic limbs with their thoughts.
“I knew about these things professionally, but it really hits home when you try to move your shoulder and nothing happens,” he says.
To make this possible, Al Muderis will surgically reconnect the boy’s severed nerves—which once controlled his arm and hand—to small, non-essential muscles in his chest. Tiny electrodes implanted under the skin will link these muscles to the prosthetic arm through eight cables connected to the titanium implant. When the boy thinks about grabbing a water bottle, his brain will activate the chest muscles, sending signals to the motors in his prosthetic hand and arm. “It’s incredible because the response is instantaneous,” Al Muderis says of TMR, though he notes the procedure isn’t widely available yet.
Integrum has also designed its implants to allow future upgrades to TMR and other advanced control systems. However, Al Muderis—who, like Brånemark, has traveled to Ukraine to provide OI for injured soldiers—says skepticism still limits the technique’s adoption, even in the UK. He partly blames strict regulations and resistance to the idea of an implant that pierces the skin: “This is a revolutionary technology that challenges many traditional orthopedic principles.”
Brånemark is more cautious but believes far more amputees could benefit from OI than the few thousand who currently have implants. When Fitzgerald O’Connor told him about his plans—and the unusual case of the one-armed prosthetist—the Swedish surgeon agreed to support the British OI team and oversee its first operation. “Many people still don’t know about OI, even in Sweden,” Brånemark says. “As someone in the field, Ashworth-Beaumont could be a great advocate.”
For weeks, his life hung in the balance. He lost nearly all liver and kidney function. Sepsis set in as he lay in a coma. His first wife and their two grown children traveled from Scotland to say their goodbyes. “The first thing I remember after waking from the coma was my daughter’s face—it’s still a vivid image in my mind,” Ashworth-Beaumont recalls. He believes his resilience comes from his father, a Liverpool docker’s son who worked as a bellboy before becoming a successful restaurateur. His mother, now in her 80s, still runs a gift shop. He also remembers a cousin who lost his legs in a car crash. “I guess amputation was always in the back of my mind,” he says.
After struggling in school, he joined the marines at 16 and thrived. Fitness was a passion, and his skills in mechanical and electronic engineering led him to prosthetics. In the final year of his degree, which he started in 1996, he worked at Steeper, a British prosthetics company that would later supply his motorized elbow. He joined the RNOH in 2005 while competing in triathlons and working as a personal trainer. He was at peak fitness when the truck hit him.
(Excerpt from newsletter promotion omitted as requested.)
Experience: I make prosthetic arms with Lego (Link to full article not included as per instructions.)Ashworth-Beaumont was amazed to be alive, but he quickly understood his physical limitations when he tried moving in his hospital bed. “I knew about these things professionally, but it really hits home when you try to move your shoulder and nothing happens,” he said. As his body began to recover, he became determined to return to work. His job required physical movement—manipulating limbs and fitting devices—so he needed a highly functional prosthetic arm. When Fitzgerald O’Connor shared his plans, Ashworth-Beaumont listened carefully. He knew it would take time, and that standard prosthetics were usually tried first.
Nearly a year after his accident, just as he was preparing to return to work, Ashworth-Beaumont received a body-powered arm through the NHS. These mechanical prosthetics are more advanced than static ones, which might include hooks or lifelike hands. By moving his shoulders, he could open a metal claw attached to a back harness by a cable. “It works,” he said, “but the technology is centuries old.”
Prosthetic sockets have existed since at least the 1500s. While materials and designs have improved, the basic principle remains the same: the socket must grip the stump securely without causing discomfort. Suction helps keep it in place, but Ashworth-Beaumont needed straps to hold his socket against his short stump, which reduced comfort and mobility. He ended up wearing the arm only a few hours a day at work, describing a frustrating cycle for arm amputees. Unlike leg prosthetics—which people rely on to avoid crutches or wheelchairs—arm prosthetics are often abandoned because people can manage with one arm. Ashworth-Beaumont believes this explains why the NHS hesitates to provide advanced arm prosthetics early on. “But the problem is, they’re not even giving people the chance to try these devices when so many of us would benefit,” he said.
To get a better prosthetic sooner, Ashworth-Beaumont went private, using money from a legal settlement with the lorry company and a family crowdfunding campaign. Working with Alan McDougall, a prosthetist at a private clinic in Surrey, he upgraded to a sleek black electric arm with motors in the elbow, wrist, and hand. He learned to flex his remaining biceps and triceps independently to control the motors via sensors in the socket. Subtle movements allowed different grips. Though not as advanced as TMR (targeted muscle reinnervation), it worked well—as I saw firsthand when he gave me one of the firmest handshakes I’ve ever had.
The electric arm, worth over £100,000, improved his abilities but also highlighted the socket’s flaws. It was heavier than the NHS version, requiring a tighter, less comfortable fit. He could pick up a mug, but the interface made precise hand movements difficult, creating a delay between thought and action. Osseointegration (OI) increasingly seemed like the solution. Ashworth-Beaumont saw himself as an ideal candidate—someone who could showcase his profession and push for wider access to advanced technology. “I feel almost obligated to explore the possibilities,” he told me when we first spoke in 2021.
He wouldn’t be the first British amputee to receive an Integrum implant. In the late 1990s, Brånemark’s devices were tested on 18 patients at Queen Mary’s Hospital in Roehampton, where the UK’s modern prosthetics industry began after World War I. While the trial had some success, the experiences of its least fortunate participants still influence discussions about NHS provision today.
Gemma Trotter, a fitness instructor from south London, was just 16 when—She lost her leg above the knee in a car accident. For years, uncomfortable prosthetic sockets held her back, but she eventually overcame her initial skepticism about osseointegration (OI), which she’d once thought was “crazy,” and joined a trial in 2003 at age 21. The results were life-changing. “Suddenly, I could feel the ground through my leg again. When I wore jeans, most people didn’t even realize I was an amputee,” she says. “I got married, had a baby… those were the best nine years of my life.”
But then the implant broke and became infected. By that time, the trial team had disbanded, leaving her with limited follow-up care. Now 42, Trotter has endured over a decade of pain and multiple attempts by surgeons, including Brånemark, to fix the issue. She’s waiting to have her third implant removed after further complications and won’t risk another. (Brånemark notes that while all implants carry some risk of failure, Integrum’s success rates have improved significantly since the Roehampton trial.)
Trotter remains one of only a few dozen OI patients in the UK, where the procedure is far less accessible than in countries with insurance-based healthcare. Hanneke Mooij, a Dutch patient, was surprised to hear how difficult OI is to obtain in the UK. She received an Integrum implant in 2022, 36 years after losing her leg in a motorcycle accident. She’s part of a group of 20 one-legged Dutch women who call themselves “the flamingos”—half of whom have had OI surgery in recent years. “I’m convinced this is the future,” she says.
Most UK OI patients are treated at Relimb, a private clinic founded in 2018 at London’s Royal Free Hospital. Its directors, Norbert Kang and Alex Woollard, use Al Muderis’s implants and have about 60 patients, nearly all funded by legal settlements after traumatic accidents. Given the challenges of the Roehampton trial, they doubt the NHS has the resources to provide the specialized, long-term care OI requires. “No matter how beneficial it is or how skilled we are now, we can’t change health economics,” Woollard says.
Others share their concerns. Nicky Eddison, chair of the British Association of Prosthetists and Orthotists, says the field already faces a staffing crisis, with some NHS trusts managing with just two specialists. “No matter the technical advances, we can’t deliver them without skilled clinicians,” she says.
Still, OI advocates argue it could save money long-term. Stephen Cruse, founder of the Amputation Foundation, had OI surgery with Al Muderis in 2016, eight years after losing his legs in a car crash in Australia. After returning to the UK, he convinced an Australian compensation scheme to fund his surgery by proving it would save costs within five years. “They were spending about £30,000 a year on sockets, liners, and maintenance,” says Cruse, who struggled with sockets but now rarely needs prosthetic adjustments.
Last December, NICE issued new guidelines, recommending OI for NHS use—but only by specially trained multidisciplinary teams. The NHS maintains its policy of limited access, citing risks and funding priorities. Fitzgerald O’Connor believes exceptions could be made for funding in rare cases and will keep pushing for broader access as evidence of OI’s benefits grows. “Restricting it to only those with vast resources does a disservice to suffering patients,” he says.
After delays from Covid and Brexit paperwork, Ashworth-Beaumont finally secured a surgery date: October 2024. “I usually take things in stride, but this feels like jumping out of a plane,” he says weeks before the operation. “You trust the systems in place, but there’s always that fear.””There’s a 1% chance things could go wrong.”
The day before his surgery at St Thomas’s Hospital in central London, I meet Ashworth-Beaumont at a private clinic near Battersea Power Station. Fitzgerald O’Connor and Aaron Saini, an orthopedic surgeon on the new OI team, have gathered amputees and medical professionals to discuss this case and prosthetic technology in general. The topic of NHS care keeps coming up.
Craig Mackinlay, a former Conservative MP from Kent, lost all four limbs to sepsis in 2023. Five months later, he received a standing ovation when he walked into the House of Commons wearing prosthetics. Fitzgerald O’Connor, who performed the amputations, watched from the public gallery. It was a triumphant return, but Mackinlay has since criticized the NHS for long waiting times and outdated prosthetics, describing early black rubber limbs as “clubs … I couldn’t see what they’d be good for apart from breaking windows or pub fights.”
Now a life peer, Mackinlay has turned to private care, funded partly by medical device companies and his own money. In a House of Lords debate this May, he said he’d still be in a wheelchair if he hadn’t gotten better prosthetics sooner. “The technology exists, but the NHS takes years to provide it,” he said. “Why are we holding people back?” In response, health minister Baroness Merron announced a review of advanced prosthetic provision. An NHS spokesperson stated that the service offers “a comprehensive package of care and support for amputees, including a range of prosthetics.”
When I ask Ashworth-Beaumont if the reality of his surgery is sinking in, he takes a deep breath. “This is all positive,” he says, his voice breaking. “Sorry, I’m just thinking about the last four years.” Fitzgerald O’Connor puts a hand on his shoulder. “It was tough, but you made it,” he says.
The next morning, Brånemark, Fitzgerald O’Connor, and Saini attach the Integrum implant to Ashworth-Beaumont’s humerus, carefully reconstructing the surrounding tissue. “I’ve been moving like I’m made of glass,” he tells me two days later over Zoom as he waits for the bone and metal to fuse.
After Christmas, he’s ready for his new arm. McDougall has modified Ashworth-Beaumont’s body-powered prosthetic to attach directly to the implant. Even with the cable and harness needed to operate the hand, he’s amazed by the improved control. “I went out for dinner with Keri on my birthday and used a knife and fork properly,” he says. “I feel more capable as a person.”
By early March, he upgrades to a full bionic arm. At Proactive, plaster casts of amputated limbs stand like sculptures in the workshop. McDougall has adapted the advanced prosthetic, adding a small cuff for muscle sensors that previously sat inside the socket. The arm looks futuristic, with its carbon-fiber shell and translucent glove revealing some of the mechanics. The titanium implant bridges the gap between flesh and machine, yet when the arm hangs from Ashworth-Beaumont’s shoulder, it looks natural—his silhouette is symmetrical again.
Soon, the motors hum as he tests the bionic joints, lifting his arm above his head for the first time since the accident. McDougall fine-tunes the settings via a Bluetooth-connected iPad app. “This is really good,” Ashworth-Beaumont says as he picks up a loose screw from a workbench. Within days, he’s doing things he couldn’t before—even vacuuming feels like a privilege.
Five years…Years after his old arm seemed to wave goodbye, Ashworth-Beaumont understands the limits of the healthcare system as well as anyone. “I’ve spent about five hours with Alan today—you’d never get that much time in the NHS,” he says. While he follows the ongoing OI debate, returning to his NHS job has been his greatest accomplishment. Not only can he handle the physical demands of his work, but his experience has also deepened his connection with patients. “I got quite emotional after my first few appointments,” he admits. “I truly understood how they felt.”
