Multidisciplinary Complex Amputation
Our team of specialists offers comprehensive services, including complex nerve surgeries, to prevent and ease postamputation pain.
Why choose UCLA Health for amputation care?
Losing a limb to disease or trauma is life-changing. Phantom limb pain and other postamputation issues can impact your ability to get around and enjoy life. The UCLA Health Multidisciplinary Complex Amputation Clinic brings together a team of leading specialists with expertise in amputation care.
UCLA Health is the only medical center in Southern California providing complex multidisciplinary care for patients with amputations. We offer:
- Dedicated team of specialists: Depending on your needs, your care team may include experts in orthopaedic surgery, plastic surgery, pain management, psychiatry, prosthetics and more. Our team works together to customize a treatment that helps.
- Comprehensive services: We see patients who need amputations, as well as those experiencing pain or prosthesis issues after amputation. With our full breadth of medical and surgical treatments, we can help when others can’t.
- Advanced nerve procedures: We’re experts in complex nerve surgeries that prevent or ease postamputation pain. Treatments include regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR). These procedures may take place during amputation or afterward.
- Bone-anchored prosthesis (osseointegration): We’re one of a few centers in the region performing osseointegration. This advanced procedure allows a prosthetic device to connect to a bone-anchored implant. Patients can better move their prosthesis with less pain and fewer complications.
- Expert pain management: Your care team may recommend pain relief therapies such as medications and spinal cord stimulators. We also offer noninvasive scrambler therapy and transcranial magnetic stimulation (TMS). These therapies use safe electrical impulses to change how the brain receives and processes pain signals.
- Prosthetics and physical therapy: Our board-certified prosthetics experts work with patients to choose the prosthetic device that’s right for you and help you adapt to it. Patients may also receive physical therapy to improve muscle strength, movements and function.
- Convenient care: Our location is conveniently located at UCLA Health in Westwood. We also offer telehealth consultations and second opinions.
Who can benefit from the Amputation Clinic?
We provide expert care for patients who:
- Need amputation surgery
- Have postamputation pain
- Experience prosthesis difficulties due to soft tissue problems and pain
- Want a bone-anchored (osseointegrated) prosthesis
Your multidisciplinary care team
Specialists at our clinic work together to customize treatments that offer symptom relief.
You may receive care from experts in:
Tests and treatments we offer
Our team works together to customize a treatment plan that helps prevent or ease postamputation pain. We expertly diagnose the cause of pain and offer a full range of nonsurgical and surgical therapies.
Tests to diagnose postamputation pain
In most cases, our team pinpoints the cause of postamputation pain through a physical exam and review of symptoms.
These tests can help confirm a neuroma diagnosis:
- Imaging test, such as an MRI
- Injection of numbing medication (nerve block) to see if pain symptoms improve
Amputation nerve surgeries
Our fellowship-trained orthopaedic and plastic surgeons perform two types of complex nerve surgeries that prevent and ease postamputation pain. Your surgical team will discuss the best option for you.
Nerve surgeries may take place during amputation or any time afterward. These procedures:
- May prevent postamputation pain from happening when performed at the time of amputation
- Treat neuromas, phantom limb pain and residual limb pain that occur after amputation
- Improve the ability to control and move certain prosthetic devices that use electrical signals sent from muscles
Depending on your specific situation, you may benefit from:
- Regenerative peripheral nerve interface (RPNI) surgery
- Targeted muscle reinnervation (TMR) surgery
- Combination of both procedures
Regenerative peripheral nerve interface (RPNI) surgery
RPNI surgery involves covering cut nerve endings with small pieces of muscle taken from another body part (grafts). The nerves regenerate, growing into the muscle graft in an orderly way that doesn’t cause a neuroma or pain.
Targeted muscle reinnervation (TMR) surgery
TMR surgery reroutes cut nerves into a nearby nerve branch that activates muscles. The relocated nerves regenerate, easing pain. They also send signals to the muscles, which can improve control of certain prosthetic devices.
Osseointegration (bone-anchored prosthesis)
Osseointegration is an advanced reconstructive surgery that takes place during or after amputation. Your provider places a metal implant into the bone of the residual limb. The implant connects to a prosthesis.
We’re one of a select few centers in the region offering osseointegration for the upper and lower limbs, as well as thumbs.
This two-stage surgical procedure involves:
- Placing a metal implant into the bone of the residual limb
- Performing RPNI or TMR during implantation, if needed
- Waiting approximately three to six months for the bone to grow around the implant, securely anchoring it in place
- Performing a second procedure to create an opening (stoma) in the skin of the residual limb
- Connecting a metal rod to the implant through the stoma
- Connecting a prosthetic device to the rod and implant
Osseointegration benefits
Compared to a traditional socket prosthesis, a bone-anchored prosthesis may improve quality of life in several ways:
- Makes it easier to walk with a more natural gait
- Eliminates socket prosthesis-related problems, such as skin irritation and pressure sores
- Improves your ability to sense body movements and position (proprioception)
- Increases your energy level because it takes less effort to move
- Reduces the risk of neuromas and postamputation pain
Pain management
Our pain management and psychiatry experts offer a range of pain relief therapies, including:
- Medications: Pain-relieving medications include nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain relievers, antidepressants, beta blockers and muscle relaxers.
- Spinal cord stimulation: A small, implanted device delivers safe electrical impulses to the spinal cord to block pain sensations.
- Scrambler therapy: With , removable electrodes placed on the skin around the pain site send safe electrical impulses to damaged nerves. The impulses mix up, or scramble, nerve signals. The painful area receives signals from nearby nerves that aren’t damaged.
- Transcranial magnetic stimulation (TMS): TMS sends gentle magnetic pulses to the brain to change patterns that cause chronic pain, depression and other conditions.
Prosthetics and physical therapy
Our board-certified prosthetics experts ensure a proper device fit and help manage issues, such as skin irritation. Patients who get nerve surgery may need a different prosthesis after treatment. Our physical therapists work with you when needed to improve muscle strength, movements and function.
Find your care
We help manage postamputation pain and improve your quality of life. To learn more about our Multidisciplinary Complex Amputation Clinic or to make an appointment, call . For oncology patients, please call to schedule an appointment.