Joanneth M. Padro-Serrano, MD
Resident
VA Caribbean Healthcare System
San Juan, Puerto Rico, United States
Edgar A. Perez-Curet, MD
Resident
VA Caribbean Heakthcare Systems
Bayamon, Puerto Rico, United States
Ana M. Cintron, MD
Attending/MD
VA Caribbean Healthcare System
San Juan, Puerto Rico, United States
Osteophyte formation in the residual limb of a non-traumatic amputation
Case Description:
A 62-year-old male underwent a right transfemoral amputation due to acute limb ischemia and experienced post-operative complications, including a residual limb abscess and ulcer. The patient underwent prosthetic training with adequate gait. During the following twelve weeks, he could not tolerate the prosthesis, reporting distal residual pain and friction-like sensations. Examination revealed a clicking sound over the distal femur, and imaging showed a distal aggressive bony edge. Residual limb revision surgery found osteophyte formation, potentially related to friction from redundant tissue with prosthesis use. Surgery addressed the bony irregular border and redundant tissue, significantly improving his symptoms. He is currently using a prosthesis with adequate gait.
Discussions:
Post-amputation pain is a common occurrence in amputees, which can be classified into various types, including residual limb pain (RLP) and phantom limb pain, among others. RLP can result from painful scars, neuromas, bursitis, and other conditions, typically developing weeks or months after the amputation and decreasing as the healing process occurs. However, osteophyte formation is a rare cause of RLP, leading to severe dysfunction and difficulties in fitting a prosthesis. In such cases, surgical osteophyte removal may be necessary, significantly improving prosthetic fitting, comfort, rehabilitation progress, and quality of life. This case underscores the importance of thorough evaluation, diagnosis, and management in ensuring successful amputee rehabilitation.
Conclusions:
This case demonstrates how osteophyte formation in a residual limb can be a rare cause of pain in non-traumatic amputations. This issue can greatly restrict prosthetic fitting and ambulation with a prosthesis. It also emphasizes the importance of a thorough examination and proper management to enhance rehabilitation outcomes in amputee patients.
