Comparative Effectiveness of Targeted Muscle Reinnervation vs. Regenerative Peripheral Nerve Interface Following Lower Limb Amputation: A Systematic Review.
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Residual and phantom limb pain following lower extremity amputation have profound biopsychosocial implications. Regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR) have been shown to prevent neuroma formation and address chronic pain in the setting of lower extremity amputation. However, the comparative safety and efficacy of these techniques is unknown. This systematic review aimed to compare the effectiveness and safety of RPNI and TMR following lower extremity amputation.
Methods
A PRISMA-compliant systematic review of the MEDLINE, EMBASE, CENTRAL, SCOPUS, WebofScience, and clinicalTrials.gov databases was conducted until October 2024. All clinical studies that reported outcomes following lower extremity amputation and RPNI or TMR in adult patients were included.
Results
Four databases and two registers identified 2966 papers. Collectively, 13 studies met full inclusion criteria and reported outcome data on 499 participants who underwent
lower extremity amputation with either RPNI (n= 100) or TMR (n= 399). No comparative studies were identified. Both RPNI and TMR have independently shown improvement across PROMS, reduction in medication dependence, and increased prosthesis adherence.
Conclusion
Current data suggest that TMR and RPNI are effective techniques for reducing the incidence of phantom limb pain following lower extremity amputation. However, there is a paucity of comparative data. To address this, core outcome sets for patients undergoing lower extremity amputation with adjunctive TMR/RPNI should be established to permit comparative analysis of safety and effectiveness in future studies.
Residual and phantom limb pain following lower extremity amputation have profound biopsychosocial implications. Regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR) have been shown to prevent neuroma formation and address chronic pain in the setting of lower extremity amputation. However, the comparative safety and efficacy of these techniques is unknown. This systematic review aimed to compare the effectiveness and safety of RPNI and TMR following lower extremity amputation.
Methods
A PRISMA-compliant systematic review of the MEDLINE, EMBASE, CENTRAL, SCOPUS, WebofScience, and clinicalTrials.gov databases was conducted until October 2024. All clinical studies that reported outcomes following lower extremity amputation and RPNI or TMR in adult patients were included.
Results
Four databases and two registers identified 2966 papers. Collectively, 13 studies met full inclusion criteria and reported outcome data on 499 participants who underwent
lower extremity amputation with either RPNI (n= 100) or TMR (n= 399). No comparative studies were identified. Both RPNI and TMR have independently shown improvement across PROMS, reduction in medication dependence, and increased prosthesis adherence.
Conclusion
Current data suggest that TMR and RPNI are effective techniques for reducing the incidence of phantom limb pain following lower extremity amputation. However, there is a paucity of comparative data. To address this, core outcome sets for patients undergoing lower extremity amputation with adjunctive TMR/RPNI should be established to permit comparative analysis of safety and effectiveness in future studies.
Date Acceptance
2025-07-31
Citation
International Journal of Surgery
ISSN
1743-9159
Publisher
Elsevier
Journal / Book Title
International Journal of Surgery
Copyright Statement
Copyright. This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
Publication Status
Accepted