(P 480) TARGETED MUSCLE REINNERVATION FOR HIP DISARTICULATION - EVALUATION OF EARLY FUNCTIONAL OUTCOMES

Objective: Following hip disarticulation, poor outcomes related to pain and return to activities of daily living have been reported. Targeted muscle reinnervation (TMR) at the time of extremity amputation has been shown to improve phantom limb pain and quality of life. The objective of this study was to report on pain and functional outcomes of patients who underwent TMR concurrently with hip disarticulation.

Methods: Patients treated from 2018-2023 were included for analysis if they underwent hip disarticulation and had concurrent TMR surgery. Data extracted included demographic information, indication for surgery, symptoms prior to operation, relevant nerve coaptation, operative time, peri- and post-operative complications (hematoma, seroma, need for re-operation, etc.), and functional outcomes.

Results: Five patients (median age of 64; 3 male, 2 female) underwent hip disarticulation for sarcoma (3) or megaprosthetic infection (2). Nerve coaptation included sciatic (5/5) and femoral (2/5). Motor end points were semitendinosus (tibial component target), semimembranosus and biceps femoris (peroneal component target), and vastus medialis (femoral nerve target). No patients experienced hematoma, seroma, or infection peri-operatively. Median follow-up was 13 months. All patients had no or only mild (3/10) phantom limb pain at follow-up. Patient descriptions of functional abilities post-operatively included ambulating well with prosthesis, performing yardwork, and fishing.

Conclusion: In this small cohort of patients, pain and functional outcomes were found to be favorable to previous reports in the literature at latest follow-up. Future multi-institutional studies with larger patient groups should be performed prior to wide application of these findings.