Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees

Mitchell A. Pet, Jason H. Ko, Janna L. Friedly, Douglas G. Smith

To describe the outcomes of traction neurectomy as a surgical treatment for symptomatic neuroma of the residual lower extremity, and to identify clinical and/or demographic factors associated with an increased likelihood of persistent or recurrent pain after surgery. Retrospective Cohort Study SETTING:: Amputee clinic at a Level I Trauma Center PATIENTS:: Inclusion required a history of transfemoral or transtibial amputation, and a history of symptomatic neuroma(s) at the residual limb treated with traction neurectomy. 12 months of clinical follow-up OR the recurrence of neuroma-type pains was required for inclusion. 38 patients (63 nerves) comprised the study group. Traction neurectomy for treatment of symptomatic neuroma MAIN OUTCOME MEASURES:: The primary outcome was the presence or absence of persistent or recurrent neuroma-type pain at last follow-up. The secondary outcome was reoperation for persistent or recurrent symptomatic neuroma. 16 of 38 patients (42%) had recurrent or persistent neuroma-type pain at a mean follow-up of 37 months (range, 11-91 months), and 8/38 (21%) have undergone subsequent surgical treatment. Among the demographic and clinical features examined, only male gender was found to be a statistically significant predictor of persistent or recurrent neuroma-type pain. Traction neurectomy results in a high rate of persistent or recurrent neuroma-type and that surgeons should be cautious when considering it for the treatment of symptomatic neuroma of the residual lower extremity. Furthermore, efforts to identify better surgical and non-surgical treatments for this problem are justified. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.