The influence of nerve surgical techniques at time of amputation on the prevalence of heterotopic ossification in transtibial amputees.

Autor: Raasveld FV; Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, United States., Lehle CH; Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Hwang CD; Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, United States., Cross RE; Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Husseini JS; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Simeone FJ; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Newman ET; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Tuaño K; Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, United States., Lozano-Calderón SA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States., Valerio IL; Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, United States., Eberlin KR; Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, United States. Electronic address: keberlin@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Nov 20; Vol. 56 (2), pp. 112047. Date of Electronic Publication: 2024 Nov 20.
DOI: 10.1016/j.injury.2024.112047
Abstrakt: Background: Heterotopic ossification (HO) can form after amputation and may cause pain and functional impairment. We aimed to describe the prevalence of HO in a civilian population of transtibial amputees. We hypothesized that the decreased rate of symptomatic neuroma following active nerve surgery (Targeted Muscle Reinnervation (TMR) or Regenerative Peripheral Nerve Interface (RPNI)) may subsequently lead to a lower prevalence of HO compared to passive nerve surgery (i.e. traction neurectomy) performed at the time of amputation.
Methods: Adult patients undergoing transtibial amputation at a tertiary care center between 2000 and 2023 were included. Patient data were collected through chart review. The most recent post-amputation X-ray of the residual limb was assessed for HO presence, according to the Walter Reed classification. A random subset of X-rays (10.0 %) was independently assessed by five clinicians and two radiologists, and inter-rater reliability (IRR) was calculated using Cohen's kappa (κ). Multivariable logistic regression was conducted to identify factors associated with HO presence.
Results: In total, 665 limbs of 632 patients were included. The median time between amputation and X-ray was 1.7 years (IQR: 0.3-6.2). HO was identified in 326 X-rays (49.0 %) and was commonly present on the distal residual tibia (68.1 %) and fibula (69.0 %). Traditional amputations (i.e. those without TMR or RPNI (OR: 2.0, p = 0.014)), and the presence of a symptomatic neuroma (OR: 2.3, p < 0.001), were independently associated with a higher prevalence of HO. The IRR of the two radiologists was κ = 0.99, the overall IRR of all evaluators was κ = 0.92.
Conclusions: HO is a common finding in transtibial amputees. Peripheral nerve surgerical techniques that actively address amputated nerve endings to reduce symptomatic neuroma formation may decrease the prevalence of HO.
Competing Interests: Declaration of competing interest This work was in part supported by the Jesse B. Jupiter / Wyss Medical Foundation Endowment. SL is a consultant for Onkos Inc., IlluminOss Inc. Bone Support and Johnson & Johnson Inc. and a paid speaker for Carbofix and Amgen. IV is a consultant for AxoGen Inc, Checkpoint Surgical Inc, and Integra Lifesciences Inc. KE is a consultant for AxoGen Inc, Checkpoint Surgical Inc, Integra Lifesciences Inc, Tissium, Tulavi Therapeutics Inc, and Biocircuit. FR, CL, CH, RC, JH, FS, EN and KT have nothing to disclose.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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