Background The thumb carpometacarpal (CMC) joint orchestrates pinch in its various positions, and thumb CMC osteoarthritis (OA) is a major source of orthopaedic morbidity. Self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA. Weakness is a prominent feature of the disease, but little evidence exists to quantify self-reported loss of strength with time, or to compare weakness with that of a nonarthritic population during early disease. Questions/purposes We asked: (1) Is pinch strength in subjects with early thumb CMC OA less than that in asymptomatic control subjects; and (2) weakness in which pinch position (key, tripod, or tip pinch) has the strongest association with early OA diagnosis? Methods For this case-control study, we recruited 23 subjects who were asymptomatic and 91 with early OA for comprehensive history, physical examination, strength measurements, pain surveys, and radiographic evaluation. We used multivariate logistic regression to quantify the association between declining pinch strength and early OA diagnosis after controlling for age, sex, and BMI. This analysis was performed for three different pinch positions (key, tripod, and tip pinch) to evaluate which measurement was most closely associated with diagnosis. Results Pinch strength was less in patients with early thumb CMC OA. Key pinch had the most robust association with OA diagnosis, in which a 20% decrease in key pinch strength from the control subjects' baseline was associated with a 10% increase in the OA diagnosis (95% CI, 3%-16%; p = 0.004). This had a stronger association with OA diagnosis than tip pinch, in which a 20% decrease in strength was associated with a 6% increase in early CMC OA (95% CI, 1.0%-11%; p = 0.031). Tripod pinch also was associated to a lesser extent; a 20% reduction in tripod pinch led to a 5% increase in OA (95% CI, 1.3%-9%; p = 0.048). Conclusions Decreasing pinch strength, especially key pinch, is associated with early CMC arthritis before the development of extensive radiographic disease.

No abstract

The AUSCAN and PRWHE are both valid assessments for pain and/or disability in patients with early thumb CMC OA.

Not applicable.

Introduction: Total joint arthroplasty represents the largest expense for a single condition among Medicare beneficiaries. Payment models exist, such as bundled payments, where physicians and hospitals are reimbursed based on providing cost-efficient, high-quality care. There is a need to explicitly define "quality" relevant to hip and knee arthroplasty. Based on prior quality measure research, we hypothesized that less than 20% of developed quality measures are outcome measures. Methods: This study systematically reviewed current and candidate quality measures relevant to total hip and knee arthroplasty using several quality measure databases and an Internet library search. Results: We found a total of 35 quality measures and 81 candidate measures, most of which were process measures (N = 21, 60%), and represented the National Quality Strategy priorities of patient-and caregiver-centered experience and outcomes (31%), effective clinical care (28%), or patient safety (19%). Conclusion: Various stakeholders have developed quality measures in total joint arthroplasty, with increasing focus on developing outcome measures. The results of this review inform orthopaedic surgeons on quality measures that payers could use value-based payment models like the Merit-based Incentive Payment System and Comprehensive Care for Joint Replacement. Level of Evidence: Level I, systematic review of level I evidenceT otal joint arthroplasty is a common orthopaedic procedure performed in the elective setting, making expenditures on arthritis the largest for a single condition among Medicare beneficiaries. 1 In 2014, more than 400,000 total hip arthroplasties (THAs) or total knee arthroplasties (TKAs) were performed, with the average Medicare expenditure for surgery, hospitalization, and recovery ranging from $16,500 to $33,000 across different geographic areas. [2][3][4] Despite decreasing length of hospital stays and improved outcomes, 5,6 the total expense of these procedures will continue to rise with an increase in surgical volume. [7][8][9] Given the notable cost of total joint arthroplasty to the United States health system, these procedures are becoming increasingly regulated through payment models that reimburse based on providing high-quality care. 10 For example, in 2015, the Centers for Medicare & Medicaid Services (CMS) organized a pilot program for the Comprehensive Care for Joint Replacement. This bundled payment program for THA and TKA reimburses hospitals and surgeons based on their ability to provide high-quality, cost-efficient services. 2 In value-based models, payers hold participant hospitals and surgeons financially accountable for an episode

Diagnostic II.

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a prevalent disease that causes pain and disability. Determining the progression of CMC OA is problematic given the lack of consensus for classifications and scoring systems. We performed a systematic review to (1) determine which imaging modalities or scoring systems are used to evaluate CMC OA progression, and (2) describe the progression of CMC OA through available metrics. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English language literature search was performed in July 2019 and included studies evaluating CMC OA progression with an imaging modality or radiographic scoring system, with a minimum 1-year follow-up. Studies were analyzed with respect to their methodology, scoring systems, and relevant findings. Results: The initial search yielded 4,097 articles, 10 of which met inclusion criteria. Study size varied from 32 to 289 subjects; many subjects were included in multiple cohorts. Eight studies used radiography whereas 2 used scintigraphy. Estimates of progression varied from 20% to 70% (with large variation in follow-up time); the magnitude of progression varied from 3% to 48% (joint space narrowing) and from 0.6 to 1 points (KellgreneLawrence scale). The percentage of subjects who progressed and the progression degree varied widely and depended on follow-up length and the scoring system used. Conclusions: A paucity of literature exists to measure CMC OA progression; there is a lack of uniformly accepted imaging modality, scoring system, or follow-up interval. This absence provides the opportunity to determine consensus techniques and metrics to assess the natural history of thumb CMC OA. Type of study/level of evidence: Diagnostic III.

No abstract