Captain James Murly-Gotto has served with the Scots Guards as an Armoured Infantry Platoon Commander since 2007. On the 10^th Jan 2010, James landed at Camp Bastion in Afghanistan to complete his second tour of duty for the Scots Guards.

“One of the first things I did with my platoon on arrival was to take them to the medical facility. It is top-class and I wanted them to feel reassured that if anything happened, that they would be in good hands. Little did I expect…”  he recalls.

James and his platoon had been on the ground for 10 days and were being recalled back to base on completion of a successful mission. Whilst marking out the helicopter landing site Cpt Murly-Gotto was shot in both legs; with his right leg suffering serious injuries. He radioed his status back to get a helicopter dispatched urgently. 

“By this point I had lost a lot of blood and was starting to fade but one of my Section Commanders, Sergeant Davie Walker, risked his life to support me. He kept me talking and applied tourniquets to both legs – he saved my life. Very sadly he was killed on duty in his next mission but was recognised for the courage that he displayed with a posthumous bravery award.” 

The next 48 hours were a haze. He was shot at 19:30 on the 10^th February and flown back to Camp Bastion, where he received life-saving medical attention, before being transported back to Birmingham for further operations. He had lost a lot of tissue, had a broken tibia; half of his right knee had been shot away and he suffered multi-site fractures. Amputation of the right leg was considered, but as the vessels and nerves were intact, the consultants decided to save the leg. He underwent numerous operations and wore an external fixator for 11 months. Once he could move his leg again, Cpt Murly-Gotto found that his knee was unstable, bending into positions it ordinarily wouldn’t, as well as leaving him in debilitating pain. He carried out some research, made an appointment to see Professor Cobb and set about convincing him to help develop a patient-specific implant. 

The first step was to have a report drawn up by Joint Analysis in the MSk Lab. Simon Harris created the models of the bones from CT scans obtained using the Imperial Protocol. He and Professor Cobb looked over the extent of the damage. It was clear that both the femur and tibia were badly damaged on the inside of the knee, while the rest of the joint didn’t look too bad. The ligaments couldn’t be seen because of all the metalwork inside the joint. Sudha Shunmugam in the design office at Stanmore Implants was then asked to design and manufacture the titanium and cobalt-chrome uni-knee prosthesis, which was then inserted using the Stanmore Sculptor. This robot was developed in Imperial to allow surgeons to perform operations perfectly, exactly according to the pre-operative plan. 

A combined orthopaedic and plastic surgical team performed the operation. During the operation, the team removed the screws from his knee, (from previous operations) and then used the robotic arm to prepare the bone for implant fixation. It was crucial to make bone surfaces as exact as possible, to allow his knee to be realigned from the distorted shape that had developed following the shooting. 

The implant was then fixed in place and there was no need for any ligament reconstruction. The operation went smoothly and the skin healed straightaway despite the large incision through badly damaged tissue.

Six weeks after his operation, James was walking with crutches, had regained stability and was in minimal pain.

“I have a long way to go still but I can’t believe the difference my new customised knee has made already. I now walk with the support of one crutch but am determined to be walking unaided by June this year when I get married.”

Rehabilitation now focuses on regaining full knee flexion and extension and includes visits to the Biodynamics Laboratory at the MSk Lab, so his progress can be monitored. At present, James does not know if he will be able to serve again, and is currently receiving support to do an MBA from ‘Help The Hero’s Charity’, while he recovers.