Outcomes of Ertl Osteomyoplasty Transtibial Amputation With Primary Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface.

Background: Traditional transtibial amputation (TTA) often results in inadequate residual limb stability and increased risks of phantom limb pain and residual limb pain. The Ertl osteomyoplastic TTA technique with primary targeted muscle reinnervation and regenerative peripheral nerve interface may offer solutions to improve structural stability and reduce peripheral nerve pain. We hypothesize that this advanced TTA technique may reduce phantom limb pain and residual limb pain, while improving residual limb stability, contributing to a higher quality of life compared with traditional methods. Methods: A retrospective review was conducted of 31 patients with 33 total limbs who underwent Ertl osteomyoplastic TTA with primary targeted muscle reinnervation and regenerative peripheral nerve interface during a 6-year period. Patient-reported quality of life outcomes were assessed using the EuroQol 5-dimension 5-level instrument and EuroQol visual analog scale. Results: At a mean follow-up time of 49.3 months, results suggested high quality of life outcomes with an average EuroQol 5-dimension 5-level instrument index score of 0.879 ± 0.231 and a visual analog scale score of 89.36 ± 11.26. Patients reported low levels of pain, minimal psychological distress, and mild limitations in mobility, usual activities, and self-care, indicating favorable physical and emotional outcomes. Conclusions: This case series highlighted the value of this more technically complex procedure, which, despite increased operative time and learning curve, is associated with reduced postoperative pain, enhanced limb stability, and improved psychosocial outcomes. These findings support continued adoption and underscore the need for future comparative studies to establish superiority over traditional techniques.