Stump pain management in patients with lower limb osseointegration

The study aims to define a management protocol to outline a variety of clinical presentations associated with residuum pain after osseointegration. This is expected to assist clinicians in diagnosing and treating adverse events. In the present cohort study, a total of 406 patients with 429 (262 transfemoral and 167 transtibial) osseointegration cases were evaluated over the period spanning from November 2010 to November 2023 at Macquarie University and Norwest Private Hospital. International patients were excluded from the study due to the lack of detailed imaging and regular follow-up care. The average follow-up since surgery was found to be 6.1 ± 2.49 years. The stump pain management protocol was developed by retrospective analysis. Residuum pain is driven by mechanical, neuropathic, and infectious processes. Stump infections were categorized according to the OGAAP classification. Mechanical pain caused by aseptic or septic loosening was classified into grading systems to segregate the management. After clinical and radiological localization of neuroma, 94/262 ( 35.8%) transfemoral cases underwent 129 nerve-related procedures (117 TMR +12 RPNI). Out of 167 transtibial cases, 65 nerve interface procedures (61 TMR+4 RPNI) were performed in 42 (28.1%) cases on single or multiple nerves. Stump refashioning procedures were carried out in 115 cases (85/262 (32.4%) transfemoral; 30/167 (17.9%) in transtibial) who had pain due to recurrent soft tissue infections and overhanging soft tissues. The analysis of the average time between refashioning surgery and index surgery revealed a mean interval of 2.86 ±1.98 years. The use of bone-anchored prostheses, whilst safe and highly successful, necessitates a long-term commitment, with a potential need for ongoing management of adverse events. Based on radiographic and clinical data, the resultant categorization corresponds with related soft-tissue or bony pathology, which allows the surgeon to decide on the best course of management.