Clinical Orthopaedics and Related Research®

, Volume 472, Issue 10, pp 2991–3001

Does Targeted Nerve Implantation Reduce Neuroma Pain in Amputees?

  • Mitchell A. Pet
  • Jason H. Ko
  • Janna L. Friedly
  • Pierre D. Mourad
  • Douglas G. Smith
Symposium: Recent Advances in Amputation Surgery and Rehabilitation

DOI: 10.1007/s11999-014-3602-1

Cite this article as:
Pet, M.A., Ko, J.H., Friedly, J.L. et al. Clin Orthop Relat Res (2014) 472: 2991. doi:10.1007/s11999-014-3602-1

Abstract

Background

Symptomatic neuroma occurs in 13% to 32% of amputees, causing pain and limiting or preventing the use of prosthetic devices. Targeted nerve implantation (TNI) is a procedure that seeks to prevent or treat neuroma-related pain in amputees by implanting the proximal amputated nerve stump onto a surgically denervated portion of a nearby muscle at a secondary motor point so that regenerating axons might arborize into the intramuscular motor nerve branches rather than form a neuroma. However, the efficacy of this approach has not been demonstrated.

Questions/purposes

We asked: Does TNI (1) prevent primary neuroma-related pain in the setting of acute traumatic amputation and (2) reduce established neuroma pain in upper- and lower-extremity amputees?

Methods

We retrospectively reviewed two groups of patients treated by one surgeon: (1) 12 patients who underwent primary TNI for neuroma prevention at the time of acute amputation and (2) 23 patients with established neuromas who underwent neuroma excision with secondary TNI. The primary outcome was the presence or absence of palpation-induced neuroma pain at last followup, based on a review of medical records. The patients presented here represent 71% of those who underwent primary TNI (12 of 17) and 79% of those who underwent neuroma excision with secondary TNI (23 of 29 patients) during the period in question; the others were lost to followup. Minimum followup was 8 months (mean, 22 months; range, 8–60 months) for the primary TNI group and 4 months (mean, 22 months; range, 4–72 months) for the secondary TNI group.

Results

At last followup, 11 of 12 patients (92%) after primary TNI and 20 of 23 patients (87%) after secondary TNI were free of palpation-induced neuroma pain.

Conclusions

TNI performed either primarily at the time of acute amputation or secondarily for the treatment of established symptomatic neuroma is associated with a low frequency of neuroma-related pain. By providing a distal target for regenerating axons, TNI may offer an effective strategy for the prevention and treatment of neuroma pain in amputees.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Mitchell A. Pet
    • 1
  • Jason H. Ko
    • 1
  • Janna L. Friedly
    • 2
  • Pierre D. Mourad
    • 3
  • Douglas G. Smith
    • 4
  1. 1.Division of Plastic and Reconstructive SurgeryUniversity of Washington, Harborview Medical CenterSeattleUSA
  2. 2.Department of Rehabilitation MedicineUniversity of Washington, Harborview Medical CenterSeattleUSA
  3. 3.Department of Neurological SurgeryUniversity of WashingtonSeattleUSA
  4. 4.Department of Orthopaedics and Sports MedicineUniversity of Washington, Harborview Medical CenterSeattleUSA