A team of researchers conducted cross-sectional surveys to evaluate pain outcomes in patients with single-stage lower-limb osseointegrated implants. The study’s conclusion suggested that osseointegration (OI) with and without concurrent nerve reconstruction may reduce pain interference and improve patient outcomes, and that targeted muscle reinnervation (TMR) alone is not as powerful at controlling pain as combining TMR with regenerative peripheral nerve interface (RPNI).
The 21 surveyed participants were treated at the Hospital for Special Surgery, New York, from 2019 to 2024. Eleven patients had transfemoral amputations and ten had transtibial amputations. Nerve reconstruction procedures included TMR, RPNI, or a combined approach that was introduced into clinical practice in 2022.
The surveys collected data about phantom limb pain intensity, residual limb pain intensity, and from the Pain Interference Short Form 8a (PROMIS PI-SF 8a).
Five participants were surveyed preoperatively, five at six months postoperatively, six at one-year postoperatively, and five participants at two or more years postoperatively.
In the six-month group, four out of five participants received nerve reconstruction, all with the combined TMR-RPNI approach. In the one-year group, five out of six participants received nerve reconstruction (four with the combined TMR-RPNI approach and one with RPNI only). In the two-plus year group, nerve reconstruction was completed with TMR only in four out of five participants.
Phantom limb pain intensity and residual limb pain intensity were collected on a scale of zero to ten. The average phantom limb pain score was 2.8 in the preoperative group, 2.2 in the six-month group, and 1.2 in the one-year group, while the two-plus year cohort reported an average phantom limb pain intensity of 4.
The average residual limb pain score was 4 in the preoperative group, 1.2 in the six-month group, 2.5 in the one-year group, and 3.2 at two-plus years.
The pain interference T-score was 62 in the preoperative group, 43.4 in the six-month group, 48.2 in the one-year group, and 53.7 in the two-plus years group. A change in the PROMIS PI-SF 8a T-scores of four to five is considered clinically significant.
The study, “Navigating pain: A cross-sectional analysis of pain interference and outcomes in amputees with osseointegrated implants,” was published in Plastic & Reconstructive Surgery.
