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Barrett PC, Hackley DT, Lockhart ES, Yu-Shan AA, Bravo CJ, Apel PJ. What Factors Influence Variability in Thumb Carpometacarpal Arthroplasty Care? A Survey of ASSH Members. Hand (N Y) 2023:15589447231188454. [PMID: 37575026 DOI: 10.1177/15589447231188454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND The purpose of this study was to gather information regarding current practices in the care of carpometacarpal (CMC) arthroplasty including the use of hand therapy, immobilization, and surgical technique, and to determine which factors influence these patterns. METHODS We conducted a survey from February 24, 2022, through March 26, 2022, of 3648 currently practicing members of the American Society for Surgery of the Hand. We developed an 11-item questionnaire that contained questions about surgical technique, immobilization, and postoperative therapy utilization. Results were analyzed using chi-square analysis and a Bonferroni correction was applied to account for multiple comparisons. Statistical significance was set at a P-value of less than .05. RESULTS A total of 811 hand surgeons completed the survey (22% response rate). Surgeons who are employed by the same medical center as their hand therapist use more in-person hand therapy than surgeons with other types of business relationships. Surgeons with more than 25 years of experience are less likely to recommend therapy routinely, more likely to use ligament reconstruction and tendon interposition, and less likely to be an employee of the same medical center as their hand therapist. The length of immobilization and the time at which hand therapy began were related to surgical technique. CONCLUSIONS Variability in hand therapy usage after CMC arthroplasty is at least partially explained by business relationships with hand therapists and surgeon experience. Variability in the length of immobilization and the beginning of hand therapy postoperatively was more associated with surgical technique.
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Affiliation(s)
| | - Darren T Hackley
- Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA, USA
| | - Ellen S Lockhart
- Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA, USA
| | - Andrea A Yu-Shan
- Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA, USA
| | - Cesar J Bravo
- Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA, USA
| | - Peter J Apel
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA, USA
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Wouters RM, Tsehaie J, Hovius SE, Dilek B, Selles RW. Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature. Arch Phys Med Rehabil 2018; 99:1177-1212.e2. [DOI: 10.1016/j.apmr.2017.09.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
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Toffoli A, Teissier J. MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 80 Patients With More than 6 Years of Follow-Up. J Hand Surg Am 2017; 42:838.e1-838.e8. [PMID: 28711157 DOI: 10.1016/j.jhsa.2017.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Trapeziometacarpal (TMC) total joint replacement is increasingly being performed in Europe. MAÏA TMC total joint arthroplasty is a modular uncemented ball-and-socket hydroxyapatite-coated implant. This study assessed the midterm clinical and radiological results of the MAÏA TMC prosthesis. METHODS This single-center retrospective study involved 80 patients who underwent 96 MAÏA TMC prosthesis implantations from February 2006 to April 2009, and who had a minimum of 5 years' follow-up. Indications for the procedure were painful TMC joint osteoarthritis affecting activities of daily living and a failure of at least 6 months of nonsurgical treatment. Pre- and postoperative clinical and radiographic data were reviewed. RESULTS The mean age at surgery was 68 years (range, 53-84 years) and the median follow-up was 76 months (range, 60-102 months). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 17.5 ± 16. The mobility of the thumb was restored to a range of motion comparable with that of the contralateral thumb. Opposition, defined by the Kapandji score, was almost normal (9.2 of 10; range, 6-10), as was the final mean key pinch and grip strength, which improved by 26% and 43%, respectively. Among the 96 implants, 4 (4.2%) were surgically revised for trapezium loosening. One dislocation was treated with closed reduction; 3 (3.1%) posttraumatic trapezium fractures were immobilized for 8 weeks. Among the 26 preoperative reducible z-deformities, only 5 (19.2%) were not totally corrected after surgery. The procedure success, by survival analysis over 6 years, was 93% (95% confidence interval, 87-98). CONCLUSIONS MAÏA TMC total joint arthroplasty may be a reliable treatment option for TMC joint osteoarthritis, with very good results for pain relief, strength, mobility, and restoration of the thumb length, providing correction of most thumb z-deformities. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Adriano Toffoli
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Lapeyronie University Hospital, Montpellier, France.
| | - Jacques Teissier
- Division of Shoulder, Hand and Upper Extremity Surgery, Clinique Beau Soleil, Polyclinique Saint Jean, Montpellier, France
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Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. WITHDRAWN: Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2017; 4:CD004631. [PMID: 28368089 PMCID: PMC6478278 DOI: 10.1002/14651858.cd004631.pub5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement). We did not find any studies that compared surgery with sham surgery or surgery with non-surgical interventions.Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery or to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie University ClinicMacquarie Hand Therapy2 Technology PlaceMacquarie UniversityNew South WalesAustralia2109
| | - Toby Vinycomb
- Monash UniversityDepartment of Surgery (MMC)MelbourneAustralia
| | - Emma Carr
- Pacific Hand Therapy Services812 Pittwater RoadDee WhyNew South WalesAustralia2099
| | - Ian Edmunds
- Hornsby Hand Centre2/49 Palmerston RdHornsbyNew South WalesAustralia2077
| | - Louise Ada
- University of SydneySchool of PhysiotherapyCumberland CampusPO Box 170LidcombeNew South WalesAustralia1825
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Abstract
Introduction The purpose of this study was to evaluate a newly developed trapeziectomy rehabilitation protocol. Variability in trapeziectomy rehabilitation protocols and the arrival of new surgeons in our hospital required a uniform protocol. Methods Fifty hands in 44 patients (32 women/12 men) were immobilised for 4 weeks in a plaster cast after a trapeziectomy. A carpometacarpal splint immediately followed for 2 weeks, taken off for exercises and self-care. Patients were assessed preoperatively and at 3, 6 and 12 months using: a pain visual analogue scale (VAS), grip, tip pinch and lateral pinch strength, goniometry, the Modified Kapandji Index (MKI), the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Q-DASH, Dutch version) and the Short Form 36 (SF-36, Dutch version). At 3, 6 and 12 months, patient’s satisfaction with the operation was rated on a satisfaction VAS. Results The correlation between pain and patient satisfaction was significant ( ρ = −0.80). VAS pain improved from a median of 75 mm preoperatively to 20 mm at 12 months ( p < 0.01). The Q-DASH improved from a median of 48 preoperatively to 20 at 12 months ( p < 0.01). Median grip, tip pinch and lateral pinch strength increased at 12 months by 19%, 8% and 24%, respectively from the baseline measurement. Conclusions Patients participating in a standardised protocol after trapeziectomy with 4 weeks immobilisation demonstrated improvements in pain, Q-DASH, grip strength, tip pinch and lateral pinch grip. They were satisfied with the results. Further research into the optimal immobilisation time after trapeziectomy surgery is needed.
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Pomares G, Delgrande D, Dap F, Dautel G. Minimum 10-year clinical and radiological follow-up of trapeziectomy with interposition or suspensionplasty for basal thumb arthritis. Orthop Traumatol Surg Res 2016; 102:995-1000. [PMID: 27843078 DOI: 10.1016/j.otsr.2016.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/03/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS The aim of this article is to analyze clinical and radiological outcomes of trapeziectomy performed for basal thumb arthritis after a minimum follow-up of 10 years to gain further insight from shorter and medium-term studies reporting satisfactory evolution. METHODS We reviewed 67 trapeziectomies, operated on by the same senior surgeon after a minimum follow-up of 10 years. The sample included 16 cases of suspensionplasty and 51 interpositions. Clinical outcome evaluated strength, pain, joint amplitude, Kapandji opposition score, Disabilities of the Arm, Shoulder and Hand score, complications and revision surgery. Radiological evaluation criteria included osteoarthritis and collapse of the trapezial void. RESULTS After a 10-year follow-up, clinical results remained stable despite radiological degradations. Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive, with interpositioning as an isolated procedure appearing, clinically, to be the preferred treatment despite greater radiological degradation when compared to suspensionplasty. CONCLUSION In addition to offering insight into minimum 10-year follow-up, this study also pinpoints this paradoxical dissociation of clinical-radiological outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- G Pomares
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Galle, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - D Delgrande
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Galle, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - F Dap
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Galle, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - G Dautel
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Galle, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
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Shapiro PS, Diao E, Givens LM. Meniscal allograft arthroplasty for the treatment of trapeziometacarpal arthritis of the thumb. Hand (N Y) 2015; 10:407-16. [PMID: 26330771 PMCID: PMC4551622 DOI: 10.1007/s11552-014-9737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Arthritis at the trapeziometacarpal joint of the thumb is common. Several surgical options exist showing favorable results. We report the outcomes after interposition of allograft knee meniscus for thumb trapeziometacarpal arthritis. METHODS Twenty-three patients (25 thumbs) had surgery for thumb trapeziometacarpal arthritis using knee meniscal allograft tissue. Eleven thumbs had a minimum follow-up of 24 months, 2 thumbs had a minimum of 12 months, and 12 thumbs had less than 6 months. Disabilities of arm, shoulder, and hand (DASH) questionnaire scores, pain levels, grip strength, pinch strength, range of motion, and radiographic measurements were performed. RESULTS Between the preoperative and 24-month follow-up measurements, patient pain levels were reduced. There was a significant improvement in DASH scores. Comparisons between preoperative and postoperative strength measurements showed increase in grip strength and key pinch strength. Trapeziometacarpal subsidence was 5.5 %, and subluxation index measurements decreased 3.9 %. There was no clinical or radiographic evidence of foreign body reaction and no other complications occurred. CONCLUSIONS The results of meniscal allograft arthroplasty are comparable to other surgical techniques for trapeziometacarpal arthritis with respect to pain, outcomes, strength, oppositional motion, complications, surgical time, cost, and return to work. The results suggest that meniscal allograft arthroplasty is a viable option in the surgical management of stages II and III arthritis of the TM joint. Further follow-up and clinical studies are warranted.
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Affiliation(s)
- Paul S. Shapiro
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3535W. Thirteen Mile Road Suite #744, Royal Oak, MI 48073 USA ,Oakland University William Beaumont School of Medicine, 2200 N Squirrel Road, Rochester, MI 48309 USA ,Michigan Orthopaedic Institute, 26025 Lahser Road, Second Floor, Southfield, MI 48033 USA
| | - Edward Diao
- University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA ,California Pacific Medical Center, 45 Castro Street, San Francisco, CA 94114 USA ,San Francisco Surgery Center, San Francisco, CA USA
| | - Lynn M. Givens
- Department of Surgery, William Beaumont Hospital, 3601W. Thirteen Mile Road, Royal Oak, MI 48073 USA
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Prosser R, Hancock MJ, Nicholson L, Merry C, Thorley F, Wheen D. Rigid versus semi-rigid orthotic use following TMC arthroplasty: a randomized controlled trial. J Hand Ther 2015; 27:265-70; quiz 271. [PMID: 25091463 DOI: 10.1016/j.jht.2014.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The trapeziometacarpal (TMC) joint of the human thumb is the second most common joint in the hand affected by osteoarthritis. TMC arthroplasty is a common procedure used to alleviate symptoms. No randomized controlled trials have been published on the efficacy of different post-operative orthotic regimes. METHOD Fifty six participants who underwent TMC arthroplasty were allocated to either rigid orthotic or semi-rigid orthotic groups. Both groups started an identical exercise program at two weeks following surgery. Outcome measures were assessed by an assessor blinded to group allocation. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) and secondary outcomes included the Michigan Hand Questionnaire (MHQ), thumb palmar abduction, first metacarpophalangeal extension and three point pinch grip. Measures were taken pre-operatively, at six weeks, three months and one year post-operatively. Between-group differences were analyzed with linear regression. RESULTS Both groups performed equally well. There was no significant between-group difference for PRWHE scores (0.47, CI -11.5 to 12.4), including subscales for pain and function, or for any of the secondary outcomes at one year follow-up. CONCLUSION We found no difference in outcomes between using a rigid or semi-rigid orthosis after TMC arthroplasty. Patient comfort, cost and availability may determine choice between orthoses in clinical practice. LEVEL OF EVIDENCE 1b RCT.
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Affiliation(s)
| | - Mark J Hancock
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Leslie Nicholson
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Cathy Merry
- Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia
| | | | - Douglass Wheen
- Hand Surgery Centre, St Lukes Hospital Hand Unit, Potts Point, Sydney, Australia
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Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. We excluded trials that compared non-surgical interventions with surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement).Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone.We did not find any studies that compared any other combination of the other techniques mentioned above or any other techniques including a sham procedure. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery and we excluded studies that compared surgery to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie Hand Therapy, Macquarie University Clinic, 2 Technology Place, Macquarie University, New South Wales, Australia, 2109.
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Wu F, Shahid M, Deshmukh S. Cast immobilization does not confer additional functional benefits over immediate mobilization after trapeziectomy. J Hand Surg Eur Vol 2014; 39:885-7. [PMID: 23877726 DOI: 10.1177/1753193413497896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F Wu
- Department of Hand Surgery, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, UK
| | - M Shahid
- Department of Hand Surgery, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, UK
| | - S Deshmukh
- Department of Hand Surgery, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, UK
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Abstract
The history and evolution of both soft tissue and implant arthroplasty about the wrist are discussed, including carpometacarpal, radiocarpal, and distal radioulnar joints. Technical considerations for arthroplasty are reviewed, including factors affecting implant osseointegration, implant articulation/constraint, and management of complications.
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Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review. Adv Orthop 2012. [PMID: 23193483 PMCID: PMC3501800 DOI: 10.1155/2012/273421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. This paper aimed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer-reviewed evidence supporting their reliability, validity, and responsiveness to change. Methods. A systematic review of randomised controlled trials among people with wrist osteoarthritis was undertaken. Studies reporting reliability, validity, or responsiveness were identified using a systematic reverse citation trail audit procedure. Psychometric properties of the instruments were examined against predefined criteria and summarised. Results. Thirteen clinical trials met inclusion criteria. The most common patient-reported outcome was the disabilities of the arm, shoulder, and hand questionnaire (DASH). The DASH, the Michigan Hand Outcomes Questionnaire (MHQ), the Patient Evaluation Measure (PEM), and the Patient-Reported Wrist Evaluation (PRWE) had evidence supporting their reliability, validity, and responsiveness. A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis Hand Index as another suitable instrument that had favourable reliability, validity, and responsiveness. Conclusions. The DASH, MHQ, and AUSCAN Osteoarthritis Hand Index instruments were supported by the most favourable empirical evidence for validity, reliability, and responsiveness. The PEM and PRWE also had favourable empirical evidence reported for these elements. Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted.
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Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, Hagen KB. Systematic review of design and effects of splints and exercise programs in hand osteoarthritis. Arthritis Care Res (Hoboken) 2011; 63:834-48. [PMID: 21630479 DOI: 10.1002/acr.20427] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe and evaluate the design and effects of splints and exercise programs in hand osteoarthritis. METHODS Controlled trials identified through systematic literature reviews were included. Design of splints and exercise programs were evaluated according to existing recommendations and classification systems. The risk of bias was assessed by 2 independent reviewers and effects were summarized descriptively or by meta-analyses. RESULTS Twelve trials were included in the review: 7 assessed the effect of splints, 3 the effect of exercises, and 2 a combination of splints and exercises. The results revealed a great variety in the design of splint and exercise programs. A meta-analysis of the 2 randomized trials with low risk of bias demonstrated that splints significantly reduced hand pain at short-term (<3 months) and long-term (≥3 months) followup, with a standardized mean difference of 0.37 (95% confidence interval [95% CI] 0.03, 0.71) and 0.80 (95% CI 0.45, 1.15), respectively. Further, results from single trials indicated that hand exercises may reduce pain and increase range of motion and strength, while a combination of splints and daily exercises may reduce pain and stiffness and improve function. CONCLUSION There is consistent evidence that splints reduce hand pain, but limited evidence for the effects of hand exercises and a combination of hand exercises and splints in hand osteoarthritis.
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Suture button suspensionplasty after arthroscopic hemitrapeziectomy for treatment of thumb carpometacarpal arthritis. Arthroscopy 2010; 26:1395-403. [PMID: 20887938 DOI: 10.1016/j.arthro.2010.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 02/02/2023]
Abstract
A myriad of techniques for reconstruction of the arthritic thumb carpometacarpal joint have been described. In the modern era, there has been a push, driven by both clinicians and patients, for more rapid rehabilitation after these procedures. A majority of the historically described techniques require pinning of the thumb ray for 4 weeks. Suture button placement between the thumb and index ray metacarpals has been shown in biomechanical studies to effectively resist subsidence of the thumb ray. We describe a novel technique of using a suture button for suspensionplasty of the thumb ray after arthroscopic partial trapeziectomy. This technique allows for early mobilization and may offer a potential improvement on current techniques. Early results of use of this technique are encouraging, but well-conducted follow-up studies are necessary.
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in 2005. Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another. OBJECTIVES To compare the effect of different surgical techniques in reducing pain and improving physical function, patient global assessment, range of motion and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, to investigate whether there was any improvement or deterioration in outcomes between the 12-month review and five year follow up. SEARCH STRATEGY We searched:(CENTRAL) (The Cochrane Library 2008, issue 1), MEDLINE (1950 to Dec 2008), CINAHL (1982 to Dec 2008), AMED (1985 to Dec 2008) and EMBASE (1974 to Dec 2008), and performed handsearching of conference proceedings and reference lists from reviews and papers. SELECTION CRITERIA Randomised or quasi-randomised trials where the intervention was surgery and pain, physical function, patient global assessment, range of motion or strength was measured as an outcome. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse effects. We contacted trial authors for missing information. MAIN RESULTS We included nine studies involving 477 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty, Artelon joint resurfacing, arthrodesis and joint replacement). Studies reported results of a mixed group of participants with Stage II-IV osteoarthritis, with a range of improvement for pain and physical function. The majority of studies included in this review had an unclear risk of bias which raises some doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment or range of motion. Of participants who underwent trapeziectomy with ligament reconstruction and tendon interposition, 22% had adverse effects (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1)) compared to 10% who underwent trapeziectomy. Trapeziectomy with ligament reconstruction and tendon interposition is therefore associated with 12% more adverse effects (RR = 2.21, 95% CI 1.18 to 4.15). AUTHORS' CONCLUSIONS Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.
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Affiliation(s)
- Anne Wajon
- Hand Therapy at Hornsby, 2/49 Palmerston Rd, Hornsby, New South Wales, Australia, 2077
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Davey PA, Belcher HJCR. Effect of coexistent scaphotrapezoidal osteoarthrosis on outcome after trapeziectomy. ACTA ACUST UNITED AC 2009; 38:36-42. [PMID: 15074722 DOI: 10.1080/02844310310006440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Scaphotrapezoidal osteoarthrosis can cause persistent pain after trapeziectomy. It has previously been recommended that the scaphotrapezoidal joint should be resected at the time of trapeziectomy to avoid this complication if radiographs show evidence of joint degeneration. We have reviewed the records of 77 patients who had 87 trapeziectomies and assessed their radiographs for the presence and degree of osteoarthrosis. There was evidence of scaphotrapezoidal osteoarthrosis in almost half of the hands. Its presence, however, had no influence on subjective or objective measures of pain, function or power before or after operation, or on outcome. Only one patient required resection of the scaphotrapezoidal joint because of persistent pain. Resection of the joint cannot be recommended as a routine adjunct to trapeziectomy on radiological evidence alone.
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Affiliation(s)
- Paul A Davey
- Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, UK
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Heyworth BE, Jobin CM, Monica JT, Crow SA, Lee JH, Rosenwasser MP. Long-term follow-up of basal joint resection arthroplasty of the thumb with transfer of the abductor pollicis brevis origin to the flexor carpi radialis tendon. J Hand Surg Am 2009; 34:1021-8. [PMID: 19643289 DOI: 10.1016/j.jhsa.2009.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 03/10/2009] [Accepted: 03/18/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the long-term functional and clinical outcomes of a tendon transfer during basal joint interposition arthroplasty for osteoarthritis of the basal joint of the thumb, in which the origin of the abductor pollicis brevis (APB) and opponens pollicis is transferred to the flexor carpi radialis tendon, in order to increase the abduction moment arm of the thumb and provide dynamic stabilization of the base of the first metacarpal. METHODS We observed 22 patients, who received basal joint interposition arthroplasty with APB and opponens pollicis tendon transfer, over an average of 9 years (range, 3-20 years). Subjective outcome measures included patient satisfaction scores, visual analog scale scores for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Clinical evaluations included thumb range of motion, grip strength, and pinch strength. RESULTS At an average follow-up of 9 years, 95% of patients (21 out of 22) subjectively scored the procedure as good or excellent and reported improvement in activities of daily living. Mean visual analog scale pain score was 4.4 at rest and 7.8 with activity (out of 100), and mean DASH score was 13.3 (out of 100). Average grip strength of the operated hand was equal to that of the contralateral hand, and lateral and tip pinch strengths were 79% and 93%, respectively, of the contralateral hand. No intraoperative or early postoperative complications were reported, although 1 patient whose procedure was performed as treatment for failed silastic arthroplasty reported metacarpal instability at 9-year follow-up (DASH score of 22). CONCLUSIONS Basal joint arthroplasty with APB and opponens pollicis tendon transfers provides excellent long-term results for carpometacarpal thumb osteoarthritis. The procedure is safe, with a low complication rate. Its success has long-term durability as measured by patient satisfaction, functional outcome measures, range of motion, and strength. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Benton E Heyworth
- Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, New York, NY, USA
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Raven EEJ, Kerkhoffs GMMJ, Rutten S, Marsman AJW, Marti RK, Albers GHR. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint : comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis. INTERNATIONAL ORTHOPAEDICS 2006; 31:547-54. [PMID: 17021835 PMCID: PMC2267630 DOI: 10.1007/s00264-006-0217-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 06/09/2006] [Indexed: 01/27/2023]
Abstract
Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface's of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint.
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Affiliation(s)
- E E J Raven
- Department of Orthopaedics and Traumatology, Gelre Ziekenhuizen Apeldoorn, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands.
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Davis TRC, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am 2004; 29:1069-77. [PMID: 15576217 DOI: 10.1016/j.jhsa.2004.06.017] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 06/23/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether palmaris longus interposition or flexor carpi radialis ligament reconstruction and tendon interposition improved the outcome of excision of the trapezium for the treatment of painful osteoarthritis of the trapeziometacarpal joint. METHODS 183 thumbs with trapeziometacarpal osteoarthritis were randomized for treatment by either simple trapeziectomy, trapeziectomy with palmaris longus interposition, or trapeziectomy with ligament reconstruction and tendon interposition using 50% of the flexor carpi radialis tendon. A K-wire was passed across the trapezial void during each of the 183 surgeries to hold the base of the thumb metacarpal at the level of the index carpometacarpal joint and was retained for 4 weeks in every case. All patients wore a thumb splint for 6 weeks. Each patient had subjective and objective assessments of thumb pain, stiffness, and strength before surgery and at 3 months and 1 year after surgery. RESULTS The 3 treatment groups were well matched for age, dominance, and presence of associated conditions. Complications were distributed evenly among the 3 groups and no cases of subluxation/dislocation of the pseudarthrosis were observed. Of the 183 thumbs 82% achieved good pain relief and 68% regained sufficient strength to allow normal activities of daily living at the 1-year follow-up evaluation. Neither of these subjective outcomes nor the range of thumb movement was influenced by the type of surgery performed. Thumb key-pinch strength improved significantly from 3.5 kg before surgery to 4.6 kg at 1 year but the improvement in strength was not influenced by the type of surgery performed. CONCLUSIONS The outcomes of these 3 variations of trapeziectomy were very similar at 1-year follow-up evaluation. In the short term at least there appears to be no benefit to tendon interposition or ligament reconstruction.
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Affiliation(s)
- Tim R C Davis
- Department of Trauma and Orthopaedic Surgery, Queen's Medical Centre, University Hospital, Nottingham, United Kingdom
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