Clinical thresholds of symptoms for deciding on surgery for trapeziometacarpal osteoarthritis

Abstract

The severity of preoperative symptoms at which patients are likely to achieve a minimal important change and patient acceptable symptom state after surgery may help the decision to perform surgery for trapeziometacarpal osteoarthritis. The study objective was to define these thresholds for pain at rest and during activities as well as for the brief Michigan Hand Outcomes Questionnaire. One hundred and fifty-one patients were examined before surgery and 3, 6 and 12 months after surgery. The minimal important change after surgery was 1.9, 3.9 and 16 scores for pain at rest, pain during activities and the brief Michigan Hand Outcomes Questionnaire, respectively. The respective patient acceptable symptom state values were 1.5, 2.5 and 70 after surgery. Our results show that patients with baseline pain values between 3.5 and 5.5 at rest, between 6.5 and 7.5 during activities and a presurgery brief Michigan Hand Outcomes Questionnaire score of about 47, have the greatest chance of achieving a relevant symptom change and an acceptable symptom state. The information from this study may help surgeons in deciding the surgical indications and help patients in their expectation in symptom relief after surgery. Level of evidence: IV

Validity, responsiveness and minimal important change of the EQ-5D-5L in patients after rotator cuff repair, shoulder arthroplasty or thumb carpometacarpal arthroplasty

“…Christie et al [33] published the PASS value of 26 for the OSS based on the former scoring system, which now corresponds to a value of 34 using the current OSS scoring method that we applied in this analysis [17]. The TSA patients were distributed based on the PASS value of 33.7 for SPADI [33], and CMC I patients based on the PASS value of 70 points for the brief MHQ [34]. The Mann-Whitney U test was used to test for differences in the EQ-5D-5L utility index for patients in either a PASS or not.…”

Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty

“…We were able to define a revision algorithm that can be used as a decisionmaking aid when a patient presents with residual symptoms after resection arthroplasty. After primary thumb CMC surgery, reported pain values at rest range from 0.9 to 1.2 and 1.8 to 3.0 (during activities) (Marks et al, 2019;Wilcke et al, 2020), which are lower, and indicative of less pain compared with our respective scores of 1.6 and 2.7 after revision surgery. For hand function, brief MHQ scores of 62 to 83 (indicative of higher hand function) were reported after primary surgery (Efanov et al, 2019;Marks et al, 2019;Waljee et al, 2011) compared with the lower (worse) score of 63 in this revision series.…”

“…After primary thumb CMC surgery, reported pain values at rest range from 0.9 to 1.2 and 1.8 to 3.0 (during activities) (Marks et al, 2019;Wilcke et al, 2020), which are lower, and indicative of less pain compared with our respective scores of 1.6 and 2.7 after revision surgery. For hand function, brief MHQ scores of 62 to 83 (indicative of higher hand function) were reported after primary surgery (Efanov et al, 2019;Marks et al, 2019;Waljee et al, 2011) compared with the lower (worse) score of 63 in this revision series. These trends support the conclusion that, while most patients are satisfied with their outcome after revision surgery, this type of intervention does not yield the same positive outcomes as that of primary surgery.…”

“…The results of this study showed that patients were satisfied with the outcome of their thumb CMC revision surgery, yet there were still some residual symptoms after revision. Although the need for revision after resection arthroplasty is rare in cases of thumb CMC OA, the outcome after further surgery is less favourable than that reported after primary thumb CMC replacement arthroplasty (Efanov et al, 2019;Marks et al, 2019;Waljee et al, 2011;Wilcke et al, 2020). Therefore, it is essential to inform the patients about the possibility of persisting symptoms if revision surgery is required.…”

Letter regarding "The Efficacy of Intra-Articular Versus Extra-Articular Corticosteroid Injections in the Thumb Carpometacarpal Joint"

“…Although statistical testing revealed significant P values, the group differences in DASH and pain scores were smaller than the minimal important difference (MID); the MID ranges between 10 and 19 points for the DASH and between 1.3 and 2.1 points, on a numeric rating scale, for pain at rest. 3 , 4 , 5 Therefore, the clinical relevance of the group differences is questionable and the significant P values could, in fact, be because of chance or other, unscreened factors.…”