Objective:

This systematic review aims to compare the effectiveness of TMR and RPNI in reducing post-amputation pain, with a focus on RLP and PLP.

Background:

Post-amputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), is a prevalent and debilitating issue among amputees. Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) are surgical techniques developed to alleviate pain and prevent neuroma formation.

Design/Methods:

A comprehensive search of multiple databases, including PubMed and Scopus, was conducted for studies published up to October 2024. Clinical studies involving at least one subject were included, covering case-control, cohort, and randomized controlled trials. Key outcomes evaluated were pain relief, prosthetic functionality, complication rates, and quality of life indicators.

Results:

A total of 28 studies were included, comprising 1,110 amputees—19 studies focused on TMR, 4 on RPNI, and 3 on both techniques. Our meta-analysis, based on data from 14 studies with 457 patients, showed that 2.3% of amputees developed neuromas post-amputation (95% CI: 0.7% to 3.8%). PLP was observed in 44.8% of patients (95% CI: 30.9% to 58.7%) across 12 studies involving 417 amputees, while RLP was reported in 44.8% (95% CI: 23.3% to 66.2%) of cases in 7 studies with 291 participants. TMR studies consistently reported significant improvements in patient-reported outcomes, particularly in neuroma formation, PLP, and RLP. In contrast, RPNI studies demonstrated reductions in both phantom and residual limb pain. Additionally, the RPNI technique demonstrated improved prosthetic adherence and a reduction in analgesic use among treated groups.

Conclusions:

Both TMR and RPNI are effective in alleviating post-amputation pain, with RPNI showing potential as a preventive strategy for neuroma formation. Further research is needed to explore long-term outcomes and the possibility of combining these techniques to optimize patient care.