Research Summary

Pain Interference Improves Following Osseointegration, Nerve Reconstruction in Lower-Limb Amputees

Anthony Calabro, MA

Key Highlights

  • Pain interference scores improved at all postoperative time points compared with preoperative levels.
  • Combined TMR-RPNI nerve reconstruction was associated with lower pain scores in the first postoperative year.
  • Phantom and residual limb pain increased slightly in the 2+ year postoperative group, which mostly received TMR alone.
  • Results suggest combined nerve reconstruction techniques may offer better long-term pain control than TMR alone.

Researchers developed a cross-sectional survey to evaluate pain outcomes in amputees receiving osseointegrated (OI) prostheses, with and without concurrent nerve reconstruction. Patients who underwent the combined targeted muscle reinnervation and regenerative peripheral nerve interface (TMR-RPNI) approach reported the most favorable outcomes within the first year, while pain levels rose modestly in those assessed at more than 2 years postoperatively. These findings suggest the technique used for nerve reconstruction may influence long-term pain management success.

OI prostheses are an alternative option for patients who are amputees and experience poor tolerance to traditional socket-based systems, providing a direct skeletal attachment for the external limb. As plastic surgeons increasingly contribute to soft tissue and nerve reconstruction in these patients, understanding the impact of these interventions on pain is important to alleviate pain in this cohort.

The current study included 21 patients with lower-limb amputations—11 above-the-knee and 10 below-the-knee—who received single-stage OI implants between 2019 and 2024. Surveys capturing phantom limb pain (PLP), residual limb pain (RLP), and PROMIS Pain Interference (PI-SF 8a) scores were collected at four time points: preoperatively, 6 months, 1 year, and 2 or more years postoperatively. Nerve reconstruction techniques varied over time, with combined TMR-RPNI introduced in 2022 and more commonly applied in recent cohorts.

PLP scores declined from a mean of 2.8 preoperatively to 2.2 at 6 months and 1.2 at 1 year but increased to 4.0 in the 2+ year group. RLP showed a similar trend, decreasing from 4.0 preoperatively to 1.2 and 2.5 at 6 months and 1 year, respectively, before rising to 3.2 at 2+ years. Pain interference improved markedly, with PROMIS T-scores dropping from 62 preoperatively to 43.4, 48.2, and 53.7 at 6 months, 1 year, and 2+ years, respectively—each representing clinically significant reductions.

The authors noted that longitudinal follow-up surveys could offer a more robust examination of long-term post-OI pain management.

“Our study suggests that osseointegration with and without concurrent nerve reconstruction may reduce pain interference and improve patient outcomes,” the authors concluded.

Reference
Vaeth AM, Choate C, Kochheiser M, et al. Navigating pain: a cross-sectional analysis of pain interference and outcomes in amputees with osseointegrated implants. Plast Reconstr Surg Glob Open. 2024;[Epub ahead of print].