Journal CME November 2025: Outcomes in transhumeral upper limb amputation with osseointegration and targeted muscle reinnervation: A preliminary observational cohort study-PM R - 2025 - Webster - Outcomes in transhumeral upper limb amputation with osseointegration and targeted muscle

PM R - 2025 - Webster - Outcomes in transhumeral upper limb amputation with osseointegration and targeted muscle

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This preliminary observational cohort study examines outcomes associated with combining osseointegration (OI) and targeted muscle reinnervation (TMR) in transhumeral (TH) upper limb amputation (ULA) patients who use myoelectric prostheses. While both OI and TMR individually show promise in improving prosthetic function and reducing pain, their combined effects have been scarcely studied.<br /><br />The study involved three male cases with TH amputation who underwent both OI and TMR and compared their functional, satisfaction, quality of life, pain, prosthesis use, and patient experience measures to two matched control groups: one without TMR or OI (n=6), and one with TMR but not OI (n=7). All participants used myoelectric or hybrid prostheses.<br /><br />Key findings include:<br /><br />1. Residual Limb Health and Prosthesis Use: Cases with combined OI and TMR reported significantly better residual limb health (fewer skin complications related to socket use), greater intuitiveness of prosthesis control, and substantially increased daily prosthesis use hours compared to both control groups. Average daily prosthesis use in the cases exceeded 12 hours, much higher than controls.<br /><br />2. Functional Outcomes: Significant improvements were noted in task performance measures, including better scores on the Brief Activity Measure for ULA and Upper Extremity Functional Scale for one-handed tasks in cases versus controls, indicating enhanced functional independence.<br /><br />3. Prosthesis Satisfaction: Cases reported higher satisfaction regarding comfort, appearance, and overall prosthesis experience, particularly compared to TMR-only users.<br /><br />4. Pain: While no consistent differences emerged in residual limb pain, cases reported lower frequency of phantom limb pain and neck pain than TMR-only controls, though back pain intensity was higher in some cases.<br /><br />Limitations include the small sample size, retrospective design, potential selection bias, and heterogeneity among control participants regarding prosthesis types and control methods. Gender distribution differences between groups and recall-based surgery timelines also limit conclusions. Despite these, effect size analyses suggest clinically meaningful benefits of combining OI and TMR.<br /><br />The study concludes that the combination of OI and TMR may provide additive benefits in prosthesis intuitiveness, residual limb health, daily use, and satisfaction in TH amputation patients. The authors recommend larger, prospective studies to confirm these preliminary findings and guide rehabilitation outcomes in this emerging field.

Keywords

osseointegration

targeted muscle reinnervation

transhumeral amputation

myoelectric prostheses

upper limb amputation

prosthesis use

residual limb health

phantom limb pain

prosthesis satisfaction

functional outcomes