Surgical Management of Primary Thumb Carpometacarpal Osteoarthritis: A Systematic Review

Vermeulen, Guus M.; Slijper, Harm P.; Feitz, Reinier; Hovius, Steven E.R.; Moojen, Thybout M.; Selles, Ruud W.

doi:10.1016/j.jhsa.2010.10.028

Cited by 361 publications

(303 citation statements)

References 46 publications

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“…Variations in the treatment of electrophysiologically normal carpal tunnel syndrome are an example of this phenomenon. Large variations in treatment approach can also be ascribed, in part, to the dearth of high-quality research on OA of the hand [22,23]. In addition to high-level evidence and practice guidelines, variation may decrease with the development of methods for increasing patient involvement in their own care [14] by diminishing the influence of individual physician attitudes.…”

Section: Discussionmentioning

confidence: 99%

“…Greater variation is observed in discretionary treatment of conditions that are part of normal human aging, including benign prostate hyperplasia and osteoarthritis (OA) [2,16,21]. For such conditions, variation in patient symptom intensity and magnitude of disability are often incompletely understood, and well-designed clinical trials comparing diagnostic and treatment strategies are scarce [22,23]. In the absence of practice guidelines based on solid scientific evidence, it seems that medical decision-making may be largely determined by individual physician attitudes.…”

Section: Introductionmentioning

confidence: 99%

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Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Becker

Teunis

Blauth

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There are substantial variations in medical services that are difficult to explain based on differences in pathophysiology alone. The scale of variation and the number of people affected suggest substantial potential to lower healthcare costs with the reduction of practice variation. Our study assessed practice variation across three affiliated urban sites in one city in the United States and related healthcare costs following the diagnosis of hand osteoarthritis (OA) in patients. Questions/purposes (1) What are the factors associated with increased costs and surgery in the first year after diagnosis of hand OA? (2) How much practice variation exists among hand surgeons in terms of the number of patient visits, use of imaging tests, use of injections, occupational therapy use, and surgery? (3) What proportion of total cost is accounted for by patients who consult with an additional provider? Methods Patients receiving a new diagnosis of primary hand OA between January 1, 2007, and December 31, 2011, were identified from the research database of three affiliated urban hospitals in a single city in the United States. We included 2814 patients (69%, 1929 women) treated by six hand surgeons. We recorded all visits, imaging tests, injections, occupational therapy visits, and surgical procedures in the first year after that diagnosis. Costs were extracted from the Medicare Physician Fee Schedule. Reliability of the database was assessed by manual checking of 120 patient charts (4.3% of all data); reliability was determined to be 94% (113 of 120) for diagnoses, 97% (116 of 120) correct surgeon, 100% (120 of 120) second surgeon, 99% (278 of 282) visits, 99% (132 of 134) imaging procedures, 92% (11 of 12) injections, 95% (21 of 22) surgical procedures, and 85% (102 of 120) prescribing occupational therapy.One of the authors (SJEB) is supported by Dutch research grants from Anna Foundation|NOREF (less than USD 10,000) (Oegstgeest, The Netherlands), Genootschap Noorthey (less than USD 10,000) (Bussum, The Netherlands), Stichting Fonds Doctor Catharine van Tussenbroek (less than USD 10,000) (Amsterdam, The Netherlands), and Stichting Vreedefonds (less than USD 10,000) (Amsterdam, The Netherlands). One of the authors (TT) received research grants from the Prince Bernhard Culture Fund & Kuitse Fung (less than USD 10,000) (Amsterdam, The Netherlands) and Fundatie van de Vrijvrouwe van Renswoude te's-Gravenhage (less than USD 10,000) (The Hague, The Netherlans). One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from Wright Medical (less than USD 10,000) (Memphis, TN, USA); Skeletal Dynamics (less than USD 10,000) (Miami, FL, USA); Biomet (less than USD 10,000) (Warsaw, IN, USA); AO North America (less than USD 10,000) (Paoli, PA, USA); and AO International (less than USD 10,000) (Dubendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and boa...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Becker

Teunis

Blauth

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Surgical options include volar ligament reconstruction, 11 first metacarpal osteotomy, 13 CMC joint arthrodesis, 12 total joint arthroplasty, 1 and trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI). 3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity.…”

mentioning

confidence: 99%

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

Desai

Brogan

Richard

et al. 2016

Hand (New York, N,Y.)

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Surgery ArticleOsteoarthritis (OA) at the base of the thumb can cause severe pain, weakness, and deformity and can result in marked disability. 14 The unique anatomy of the thumb carpometacarpal (CMC) joint predisposes it to degenerative arthritis. 5,27 Specifically, the degree of weakening of the palmar beak ligament has been correlated with degenerative processes in the joint and is the target of ligament reconstruction for symptomatic arthritis. 7 Degenerative OA at the thumb CMC joint is treated initially with activity modification, splinting, medication, and intra-articular corticosteroid injections. 34 For advanced disease, or when nonoperative treatments have failed, surgical intervention can be considered. Surgical options include volar ligament reconstruction, 11 first metacarpal osteotomy, 13 CMC joint arthrodesis, 12 total joint arthroplasty, 1 and trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI). 3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity. 6,24,35,36 Advocates of this technique cite safety, ease of use, early mobilization, and good early results. 35,36 However, it is not known how effectively the SBS withstands metacarpal subsidence under loaded conditions. The purpose of this study was to biomechanically compare the more widely adopted LRTI procedure with SBS using a cadaveric model. We hypothesize that the SBS will result in a biomechanically stronger construct with immediate loading. Demonstration of an enhanced ability to withstand early active pinch while preventing metacarpal subsidence may support early motion rehabilitation protocols. Abstract Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suturebutton suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated. The thumb metacarpal was then incrementally loaded from 5 to 20 lbs, using 5-lb increments. Metacarpal subsidence during physiological key pinch and incremental loading was determined using radiographic measurements of trapezial space height. Results: The average pretesting trapezial space height did not differ significantly between the LRTI (11.9 mm) and SBS (13.7 mm) groups. After simulated physiological key pinch, the SBS group had significantly greater average trapezial space height compared with the LRTI group (8.0 mm vs 5.5 mm). For each incremental metacarpal load from 5...

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“…Studies have shown only moderate to weak reliability, little correlation with treatment choices that clinicians make [6,15,22], and poor correlation between the Eaton-Littler stage and symptom severity [4,14]. In addition, wide variation exists among surgeon preference for the surgical management options of basilar thumb arthritis [23,24], and treatment options are not easily dictated by the four EatonLittler stages. Although the classification is useful for describing the radiographic progression of thumb CMC arthrosis, it is more of historical interest and its clinical utility is limited.…”

Section: Discussionmentioning

confidence: 99%

“…Saltzherr et al [21] described higher interobserver reliability for thumb CMC and scaphotrapezial arthrosis on CT imaging compared with radiographs, which could influence surgical decision making. With all stages of CMC arthritis, severity of radiographic changes may not necessarily correlate with the surgeon's preferred treatment options, which vary extensively without clear evidence of superiority of one surgical option over others [23,24].…”

Section: Limitationsmentioning

confidence: 99%

Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis

Kennedy

Manske

Huang

2016

Clinical Orthopaedics &Amp; Related Research

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Surgical Management of Primary Thumb Carpometacarpal Osteoarthritis: A Systematic Review

Cited by 361 publications

References 46 publications

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis

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