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Incidence and associations of painful neuroma in a contemporary cohort of lower-limb amputees

Incidence and associations of painful neuroma in a contemporary cohort of lower-limb amputees

Anz Journal of Surgery 88(5): 491-496

The painful post amputation neuroma significantly impairs the prosthesis-wearing lower-limb amputee. It remains poorly understood, with literature limited to cohorts of traumatic amputees. This paper reports the incidence and associations of painful neuroma in a modern tertiary centre with a case load of amputations performed for both traumatic and non-traumatic indications. This retrospective cohort study analysed the records of 304 patients who underwent all-cause lower-limb amputation at The Alfred Hospital between January 2002 and March 2012. Patients were included in our analysis if they completed 1-year follow-up at our Amputee Rehabilitation Clinic, producing a final cohort of 96 patients. In order to identify a painful neuroma post-operatively, both clinical suspicion, and either histopathological or radiological evidence were required. The overall incidence of symptomatic neuromas was 4.17%. There was no significant difference between patients who underwent amputation for a traumatic indication (6.25% (2/32) versus 3.13% (2/64); P = 0.59) compared to non-traumatic indication (P = 0.59). Visual analogue score at discharge and the presence of phantom limb pain at follow-up showed significant associations with the formation of painful neuroma. Dose of opioid on discharge, history of depression and current smoking did not reach statistical significance. This study presents a lower incidence of painful post-amputation neuroma to those published in the literature. This may be attributed to improved methodology. The described associations require further investigation into central factors leading to neuroma sensitization.

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Accession: 065230344

Download citation: RISBibTeXText

PMID: 29654613

DOI: 10.1111/ans.14293

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