Many patients with complex regional pain syndrome type 1 (CRPS1) experience pain that is unresponsive to treatment. A research team noted that appropriate-level amputation can reliably relieve the pain, but fewer than 100 patients have been reported as receiving the surgery for that purpose, so little outcomes data exists.
To that end, the researchers evaluated three patients with severe, unremitting, knee-level CRPS1, which was recalcitrant to conservative interventions, who elected for transfemoral amputations and osseointegration (OI). After surgery, two patients gained independent ambulation; the third remained on crutches after a disrupted sciatic nerve targeted reinnervation. One uses no pain medication, one is weaning off, and one requires a reduced regimen after the revision nerve innervation.
The researchers concluded that OI seems suitable to optimize rehabilitation after amputation for CRPS1.
Patient one was a 24-year-old woman who had received multiple treatments after multiple right patella dislocations. Her initial 36-Item Short Form Survey Instrument (SF-36) bodily pain score was very severe (0/100), and her pain interference score was extreme (0/100). After OI, her bodily pain score was 60/100, and her pain interference score was 80/100.
Patient two was a 35-year-old medically discharged soldier who sustained an open left tibia fracture at age 30. Persistent infection after surgical reconstruction resulted in transfemoral amputation. He subsequently reported severe pain over most of his residual limb. His initial SF-36 bodily pain score was very severe (0/100), and his pain interference score was extreme (0/100). A sciatic nerve targeted muscle reinnervation and revision significantly reduced this pain. His latest reported bodily pain score was moderate (40/100) with a pain interference score of moderate (60/100).
Patient three was a 24-year-old woman who experienced lateral patella dislocation and meniscal tears at age 20. Despite treatment, her pain and intermittent instability persisted, leaving her unable to bear weight on the leg. Light touch elicited severe pain. Her initial SF-36 bodily pain score was very severe (0/100), and her pain interference score was extreme (0/100). After OI, her bodily pain score was 60/100, and her pain interference score was 80/100.
The open-access study, “Amputation With OI for Patients With Intractable Complex Regional Pain Syndrome,” was published in JB & JS Case Connector.
