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Kooi K, Nukala V, Smits NAF, Canta O, Ashkani-Esfahani S, Bhashyam AR. Predicting Contralateral Surgery for Trapeziometacarpal Arthrosis Within 5 Years. J Hand Surg Am 2024; 49:354-361. [PMID: 38349285 DOI: 10.1016/j.jhsa.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Symptomatic trapeziometacarpal (TMC) joint arthritis is a common cause of hand pain. It is unknown how many patients ultimately elect to have bilateral surgery for TMC arthritis. In this study, we assessed the frequency and predictive factors for contralateral TMC surgery in patients who underwent prior TMC surgery. METHODS We identified 712 patients who underwent primary surgery for TMC arthritis with a follow-up period of 5 years. We collected demographic, surgical, and follow-up data. Prediction models for contralateral surgery using a training and testing data set were created with multivariable logistic regression and random forest classifier algorithms. RESULTS At the time of initial surgery, 230 patients had bilateral thumb pain (32%), but only 153 patients ultimately had an operation for TMC arthritis on the contralateral side within 5 years (21% of 712 total patients and 67% of 230 patients with bilateral pain). Common predictive factors between both models for contralateral surgery were younger age (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.93-0.98), bilateral thumb pain (OR = 3.76; 95% CI, 2.52-5.65), and anxiety disorders (OR = 1.84; 95% CI, 1.11-3.03). CONCLUSIONS In our study, we found that the rate of contralateral surgery was 21% in patients who underwent prior TMC surgery. Predictive factors for future contralateral surgery included younger age, bilateral thumb pain, and anxiety disorder at the time of initial surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Kevin Kooi
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Musculoskeletal Health Program, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Varun Nukala
- Department of Orthopaedic Surgery, the Foot and Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nienke A F Smits
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Olga Canta
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, the Foot and Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Abhiram R Bhashyam
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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Lee KXA, Chung IT, Wang WC, Yeh CW, Ho TY, Hsu CE, Chiu YC. Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis. J Orthop Surg Res 2023; 18:934. [PMID: 38057807 PMCID: PMC10701924 DOI: 10.1186/s13018-023-04423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND A variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popular treatment methods; however, studies have showed that non-union rates were as high as 50%, with higher complications such as osteoarthritis of neighbouring joints and higher revision surgeries required as compared to other surgical methods. Patients with arthrodesis were also reported to have decreased thumb range of motion and loss of opponens function. Currently, there are numerous intraoperative positioning techniques for arthrodesis which could be confusing for young surgeons. With recent developments of fixation plates and better understanding of the wrist anatomy, this retrospective review aimed to evaluate the efficacy of our intraoperative hand-grip positioning method for arthrodesis of thumb CMCJ OA. What are the postoperative functional outcomes of (1) T-hook plates and (2) our intraoperative hand-grip positioning method for Eaton III thumb CMCJ OA arthrodesis by evaluating pain visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand questionnaires (DASH), Mayo Wrist scores, capability of thumb opposition (Kapandji score), and comparing pre- and postoperative grip and pinch strength? METHODS Twenty patients with CMCJ OA underwent arthrodesis using our intraoperative hand-grip positioning method and T-hook plates and screws (Acumed, USA). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Radiologic assessment including fusion evaluation, evaluation of radial and palmar abduction angles was done on hand X-rays. RESULTS Twenty patients with a minimum follow-up duration of 12 months were included in this study. 100% fusion rate was achieved with only 1 case of complication involving radial sensory nerve neuropathy which was resolved after removal of implant and neurolysis. Significant improvement in pain and Mayo Wrist scores were noted 3 months postoperatively, whilst DASH score exhibited significant improvements after 6 months of follow-up (p < 0.05). Even though there were no significant differences observed between preoperative and postoperative grip strength, pinch strength and Kapandji scores, positive recovery trends were noted for all parameters with these functions surpassing preoperative levels after 12 months of follow-up. Significant improvements on hand X-rays were also noted for both postoperative radial and palmar abduction angles. CONCLUSIONS There is currently no consensus on the ideal treatment method for thumb CMCJ OA. In this study, we would like to propose a simple intraoperative hand-grip positioning method with T-hook plates for arthrodesis. As seen from our results, our technique was able to provide satisfactory and replicable postoperative results and thus we would like to propose our hand-grip positioning method with T-hook plates fixation for subsequent treatment of patients with Eaton stage III thumb CMCJ OA.
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Affiliation(s)
- Kai-Xing Alvin Lee
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopaedics Surgery, China Medical University Hospital, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - I-Ting Chung
- School of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Wei-Chih Wang
- Department of Orthopaedics Surgery, China Medical University Hsinchu Hospital, Hsinchu, 302, Taiwan
| | - Chen-Wei Yeh
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopaedics Surgery, China Medical University Hospital, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopaedics Surgery, China Medical University Hospital, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
- Department of Orthopaedics Surgery, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.
- Department of Orthopaedics Surgery, China Medical University Hospital, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan.
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Fouasson-Chailloux A, Morel X, Jager T, Duysens C, Falcone A, Pomares G. Joint capsule innervation does not explain the difference in symptoms between scaphotrapezial and trapeziometacarpal osteoarthritis. HAND SURGERY & REHABILITATION 2023; 42:470-474. [PMID: 37567415 DOI: 10.1016/j.hansur.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint. MATERIALS AND METHODS We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08). RESULTS There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005). CONCLUSION The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France.
| | - Xavier Morel
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Thomas Jager
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Christophe Duysens
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Andrea Falcone
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Germain Pomares
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
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de Jong TR, Bonhof-Jansen EEDJ, Brink SM, de Wildt RP, van Uchelen JH, Werker PMN. Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial. J Hand Surg Eur Vol 2023; 48:884-894. [PMID: 37459139 DOI: 10.1177/17531934231185245] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The aim of this double anonymized, randomized controlled trial was to determine whether total joint arthroplasty has superior outcomes than trapeziectomy 1 year after surgery for trapeziometacarpal osteoarthritis. A total of 62 women aged 40 years and older, scheduled for surgery for stage II or III osteoarthritis of the trapeziometacarpal joint, were included and randomized to trapeziectomy or total joint arthroplasty. The primary outcome was the total score of the Michigan Hand Outcomes Questionnaire. Secondary outcomes were the Michigan Hand Outcomes Questionnaire subscale scores, Disability of the Arm, Shoulder and Hand Questionnaire, active range of motion, strength, return to work, patient satisfaction and complications. Data were collected at baseline and at 3 and 12 months. At 1 year, we found no superiority of total joint arthroplasty over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire. The total joint arthroplasty did show a significant advantage in strength and range of motion.Level of evidence: I.
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Affiliation(s)
- Tjeerd R de Jong
- Department of Plastic Surgery, Isala Hand-Wrist Centre, Zwolle, the Netherlands
| | | | - Sander M Brink
- Department of Rehabilitation Medicine, Isala Hand-Wrist Centre Zwolle, the Netherlands
| | - Ramon P de Wildt
- Department of Plastic Surgery, Leeuwarden Medical Centre, the Netherlands
| | | | - Paul M N Werker
- University Medical Center Groningen and University of Groningen, Department of Plastic Surgery, Groningen, the Netherlands
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Beaudart C, Li N, Boonen A, Hiligsmann M. Burden of osteoarthritis in the Netherlands: a scoping review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1147-1167. [PMID: 37728892 DOI: 10.1080/14737167.2023.2260562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To provide an overview of societal burden of osteoarthritis (OA) in the Netherlands. METHODS Medline (via Ovid) and Embase databases were searched in September 2022 for all publications providing prevalence/incidence, cost or health-related quality of life (HRQoL) data of OA (all sites) in the Netherlands. RESULTS Twenty-eight original studies were included in this scoping review; twelve reporting prevalence/incidence data of OA, seven reporting data on the economic burden of OA and twelve reporting HRQoL data of patients with OA. Most of the available data were from Dutch national cohorts. The prevalence of knee OA ranged from 6% to 18% across studies, from 4% to 7% for hip OA and from 12% to 56% for hand OA. OA was shown to be associated with impairment in work participation and long-term requirement of health care utilization, translating into substantial medical costs and societal costs of lost productivity. All studies comparing HRQoL among persons with OA with control persons showed a significantly lower HRQoL in patients with OA after adjustment for age, sex, and various risk factors. CONCLUSIONS OA is a highly prevalent disease in the Dutch population and is responsible for a significant economic and health burden.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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