Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis

Abstract

Background: With numerous treatment modalities available, it is unclear whether the treatment of recurrent Dupuytren disease is as effective as its initial treatment. We aimed to investigate the outcomes of management of recurrent Dupuytren contracture. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, MEDLINE, Embase, PubMed, CINAHL, and Cochrane Central Register of Controlled Trials were searched from their inception to April 2020. Studies of patients aged above 18 years undergoing treatment for recurrent Dupuytren contractures were included. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used for quality assessment. The study was registered with Open Science Foundation. Results: A systematic review identified 12 studies: 311 patients with 224 affected digits—index (n = 5; 2.2%), long (n = 17; 7.6%), ring (n = 57; 25.4%), small (n = 112; 50%), and unspecified (n = 33; 14.7%); of these, there were 76 metacarpophalangeal joints (MCPJ; 45.5%), 90 proximal phalangeal joints (PIPJ; 53.9%), and 1 distal interphalangeal joint (0.6%). Previous treatment included the following: percutaneous needle aponeurotomy (n = 103 of 311 patients; 33.1%), collagenase clostridium histolyticum-injection (CCH; n = 75 of 311; 24.1%), limited fasciectomy (LF) ± skin graft (n = 83 of 311; 26.7%), fasciotomy (n = 1 of 311; 0.3%), and unspecified (n = 64 of 311; 20.6%). Recurrence was treated by percutaneous needle aponeurotomy (n = 68 of 311 patients; 21.9%); CCH injection (n = 53 of 311; 17.0%); aponeurotomy or dermofasciectomy or LF (n = 176 of 311; 56.6%); ray/digit amputation (n = 8 of 311; 2.6%); and PIPJ arthrodesis (n = 6 of 293; 2.0%). Range of motion was improved by 23.31° (95% confidence interval [CI] = 13.13°-33.50°; I2 = 67%; P = .05) and 15.49° (95% CI = 2.67°-28.31°; I2 = 76%; P = .01) for MCPJ and PIPJ, respectively. Conclusions: There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture.

Real-world Medicare Healthcare Costs of Patients with Dupuytren’s Contracture Treated with Collagenase or Fasciectomy

“…The most recent systematic literature review acknowledged that inconsistency in follow-up may lead to substantial variation in reported clinical outcomes, particularly level of contracture extension, and recurrence. 29 Thus, assessing the budgetary impact of evaluated treatments over a longer time horizon may lead to different conclusions than those presented in the current study. A recent meta-analysis reported higher rates of recurrence with collagenase versus fasciectomy (6.8% versus 2.3%), but at a cost of a higher rate of complications with surgical procedures.…”

Continuous Passive Elongation Through an External Fixator: A Versatile and Beneficial Adjunct Technique to Treat Severe and Recurrent Cases of Dupuytren Contracture

“…As such, treatment selection is at the discretion of the patient and surgeon. 20 Of note, some options may make treatment of recurrence more difficult; for example, fasciectomy may be more technically difficult as a secondary procedure if CCH had been previously used. 21 Some patients may not wish to proceed with the length of treatment necessary for CPE.…”

“…Any of the conventional treatments for DC may be used to treat recurrence, although there is no current consensus on the best treatment. As such, treatment selection is at the discretion of the patient and surgeon 20. Of note, some options may make treatment of recurrence more difficult; for example, fasciectomy may be more technically difficult as a secondary procedure if CCH had been previously used 21…”

Surgical Treatment for Recurrent Dupuytren Disease

“…17 A recent meta-analysis described that a consensus on the efficacy of treatment for recurrent DD is not yet available. 18…”

“…17 A recent meta-analysis described that a consensus on the efficacy of treatment for recurrent DD is not yet available. 18 The purpose of our study was to include demographic information and describe surgical strategies used for cases of recurrent DD and report on their treatment outcomes.…”