Joint Distraction for Thumb Carpometacarpal Osteoarthritis: 2-Year Follow-up Results of 20 Patients

Abstract

Background Joint distraction is a fairly new treatment for patients with symptomatic thumb carpometacarpal osteoarthritis (CMC1 OA). A previous pilot study of five patients showed that CMC1 joint distraction is technically feasible. The current study presents the results of CMC1 joint distraction in 20 patients with a 2-year follow-up period. Purposes The primary study aim was to assess if patients with CMC1 OA have better physical function and less pain 2 years after CMC1 joint distraction. Second, we assessed the number of patients who achieved a minimal clinically important difference (MCID) in patient-reported outcome measures at each follow-up time point. Furthermore, this study sought differences on magnetic resonance imaging (MRI) of the CMC1 joint before and after distraction. Adverse events were noted and reported. Methods Twenty patients (median age of 54 years) with symptomatic CMC1 OA and an established indication for a trapeziectomy were enrolled. An external distractor device was placed over the CMC1 joint and left in situ for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), visual analogue scale (VAS), and grip strength were recorded preoperatively and at 3, 6, 12, and 24 months postoperatively. Results Two years after joint distraction, physical function and pain scores had improved significantly compared with baseline: DASH from 48 to 17, MHQ from 56 to 83, and VAS for pain from 50 to 18 mm. Fourteen of 19 patients (74%) reached an MCID in DASH and MHQ scores. One patient was not satisfied with treatment outcome and chose to proceed with a trapeziectomy 14 months after initial distraction therapy. Conclusions This study demonstrates that CMC1 joint distraction can postpone more invasive surgical interventions (e.g., trapeziectomy) for at least 2 years. Larger comparative studies are needed to assess the value of CMC1 joint distraction in the treatment of CMC1 OA. Level of Evidence This is a Level IV, prospective case series study.

A new magnetic internal distractor: cadaveric study of changes in trapeziometacarpal joint forces

“…It is minimally invasive and capable of postponing invasive procedures. It has only recently been used for OA in non-weight-bearing small joints, such as the TMJ (Ottenhoff et al., 2021; Spaans et al., 2017). Reported clinical advantages from distraction treatment include pain relief, improvement in mobility as well as cartilage repair, evident on microscopic and macroscopic assessment.…”

“…There is currently no effective treatment to postpone the development of OA. Joint distraction has recently been described (Ottenhoff et al., 2021; Spaans et al., 2017). It relieves further mechanical stress and cartilage wear, and may even cause tissue regeneration via chondrocyte repair (Lafeber et al., 2006; Van Valburg et al., 1998; Wiegant et al., 2013).…”

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score–matched Comparative Study

“…Additionally, only 42% to 55% of patients with personal injury claims experienced a clinically relevant improvement in pain after minor and major surgery, respectively. For example, when we compare this to surgery for thumb base osteoarthritis, we find that a clinically relevant improvement in pain has been reported for 71% to 84% of patients [ 18 , 27 ]. This raises the question of whether patients actually benefit from treatment while they have an ongoing personal injury claim.…”

El Osteoartritinde Güncel Tedavi Yaklaşımları

“…Yeni ancak kısmen invaziv bir metot olan eklem distraksiyonu tedavisinin semptomatik el 1.KMK eklem OA'lı 20 hastada uygulandığı bir çalışmada; sekiz haftalık eksternal fiksatör uygulamasının ikinci yılın sonunda bile ağrı ve fiziksel fonksiyon skorlarında anlamlı iyileşmeler sağladığı ve olumsuz etkilerin düşük oranda geliştiği bildirilmiştir. Bu prospektif olgu serisi çalışmasında, eklem distraksiyonunun innovatif bir eklem koruyucu teknik olduğu, trapeziektomi gibi cerrahi işlemleri iki yıl kadar geciktirebildiği, geniş kapsamlı karşılaştırmalı çalışmalarda araştırılmasının önemi vurgulanmıştır 45 .…”