From concept to clinical practice-Unraveling the adoption of regenerative peripheral nerve interface (RPNI) surgery

Postamputation pain affects up to 95% of the 2.3 million individuals with amputations in the US. Regenerative Peripheral Nerve Interface (RPNI) surgery is a promising new approach for managing postamputation pain and enhancing prosthetic control. The purpose of this study was to determine the adoption of this surgical intervention over time to provide insight for future research direction and clinical applications.

This study was designed as a trend analysis to evaluate the adoption of RPNI surgery. A comprehensive search of the PubMed and Embase databases was conducted from 2011 to 2024, with publications categorized into basic science, clinical science, and review articles. Data were extracted and analyzed for temporal and thematic patterns. To complement academic output, a pilot analysis of Google Search trends was performed using the terms "RPNI" and "Regenerative Peripheral Nerve Interface," to assess global search volume and average annual growth rates. Statististical analysis was performed using SPSS.

The search identified 233 publications, among which 106 met the inclusion criteria: 26 (24.5%) basic science articles, 40 (37.7%) clinical science articles, and 40 (37.7%) reviews. Publication output demonstrated a significant upward trajectory (p < 0.001). Overall, 82% of the publications were from the last 5 years. Thematic analysis revealed a progression from early animal model and proof-of-concept studies (2011-2015) to translational and early clinical reports (2016-2018), followed by randomized trials, case series, and comparative studies with targeted muscle reinnervation (2019-2021). The most recent years (2022-2024) were characterized by systematic reviews, multi-institutional trials, and refinements in surgical technique (e.g., vascularized and muscle cuff RPNI). Google Search data corroborated these findings, with the search volume for "RPNI" increasing by 16,307% from 2011 to 2024, demonstrating academic and public momentum.

RPNI surgery has gained significant traction over the past 14 years. Long-term clinical outcomes and patient-reported experiences should be further investigated to support the already promising basic science and clinical outcomes.