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Does Targeted Nerve Implantation Reduce Neuroma Pain in Amputees?

  • Symposium: Recent Advances in Amputation Surgery and Rehabilitation
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Author information

Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359798, Seattle, WA, 98195, USA

    Mitchell A. Pet MD & Jason H. Ko MD

  2. Department of Rehabilitation Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA

    Janna L. Friedly MD

  3. Department of Neurological Surgery, University of Washington, Seattle, WA, USA

    Pierre D. Mourad PhD

  4. Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA

    Douglas G. Smith MD

Authors
  1. Mitchell A. Pet MD
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  2. Jason H. Ko MD
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Correspondence to Mitchell A. Pet MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Pet, M.A., Ko, J.H., Friedly, J.L. et al. Does Targeted Nerve Implantation Reduce Neuroma Pain in Amputees?. Clin Orthop Relat Res 472, 2991–3001 (2014). https://doi.org/10.1007/s11999-014-3602-1

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