Poor Patient-Reported Outcomes following Surgical Treatment of Eaton Grade 1 Osteoarthritis of the Thumb Carpometacarpal Joint

Abstract

Background Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. The specific research question is, if there is a limit of radiographic changes, below which a poor patient-reported outcome (PRO) can be expected.

Purpose In a retrospective cohort of patients with prospectively collected PROs, we intend to study the effect of the radiographic CMC-1 OA severity on the PRO improvement and satisfaction after interposition arthroplasty.

Patients and Methods Radiographs of 347 patients, who had CMC-1 surgery, were retrospectively analyzed. Each rater independently assessed all radiographs classifying each according to the Eaton classification. All patients had surgery with CMC-1 interposition arthroplasty using three well-known techniques that all include a complete trapeziectomy. Comparison between stage 1 and stage 2–4 was done using Chi-square test and t-test.

Results Patients with Eaton stage 1 had a mean improvement in Quick-DASH (Quick-Disability of the Arm, Shoulder, and Hand questionnaire) scores of 14.6 points. Patients with Eaton stage 2 to 4 had a mean improvement of 25.3 points. The difference between these two groups was 10.6 points (p = 0.009). Only 52% of patients with Eaton stage 1 OA were satisfied. However, 76% of patients with Eaton stage 2 to 4 were satisfied (p = 0.008, chi-square between stage 1 and stage 2–4).

Conclusion Patients with Eaton stage 1 CMC-1 OA had poorer PROs, as compared with more advanced stages of OA, 6 months following surgical treatment with interposition arthroplasty. Based on our results, we advise against surgical treatment with interposition arthroplasty of the very mildest CMC-1 OA, regardless of the preoperative PROs.

Keywords

thumb carpometacarpal joint - Eaton - classification - radiographs - patient-reported outcomes - interposition arthroplasty

Authors' Contributions

R.W.J. conceived the study, did statistical analysis, drafting of manuscripts, gained approval from the Danish Patient Safety Authority. K.A.A. did manuscript revision and reviewed the radiographic material. C.H.J. did manuscript revision and reviewed the radiographic material. A.O. did manuscript revision and created the online system for radiographic evaluation. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Ethical Approval

The National Ethical Committee does not require ethical approval for reporting patient-reported outcome measures. The Danish Patient Safety Authority approved the study: 3–3013–2899/1.

Publikationsverlauf

Eingereicht: 23. Juni 2021

Angenommen: 03. August 2021

Artikel online veröffentlicht:
01. Oktober 2021

• References

• 1 Haara MM, Heliövaara M, Kröger H. et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 2004; 86 (07) 1452-1457
• 2 Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am 2005; 87 (12) 2614-2618
• 3 Sonne-Holm S, Jacobsen S. Osteoarthritis of the first carpometacarpal joint: a study of radiology and clinical epidemiology. Results from the Copenhagen Osteoarthritis Study. Osteoarthritis Cartilage 2006; 14 (05) 496-500
• 4 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
• 5 Weilby A. Surgical treatment of osteoarthritis of the carpo-meta-carpal joint of the thumb. Acta Orthop Scand 1971; 42 (05) 439-440
• 6 Berger AJ, Momeni A, Ladd AL. Intra- and interobserver reliability of the Eaton classification for trapeziometacarpal arthritis: a systematic review. Clin Orthop Relat Res 2014; 472 (04) 1155-1159
• 7 Ladd AL. Guest editorial: the Robert's view: a historical and clinical perspective. Clin Orthop Relat Res 2014; 472 (04) 1097-1100
• 8 Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin 1987; 3 (04) 455-471
• 9 Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br 1949; 31B [phone] , illust
• 10 Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol 2016; 41 (04) 365-366
• 11 Herup A, Merser S, Boeckstyns M. Validation of questionnaire for conditions of the upper extremity [in Danish]. Ugeskr Laeger 2010; 172 (48) 3333-3336
• 12 Health IfWa. Secondary. Available at: https://www.dash.iwh.on.ca/sites/dash/public/translations/QuickDASH_Danish.pdf
• 13 Polson K, Reid D, McNair PJ, Larmer P. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther 2010; 15 (04) 404-407
• 14 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (08) 1655-1666
• 15 Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg Am 2001; 26 (04) 686-691
• 16 Diaconu M, Mathoulin C, Facca S, Liverneaux P. Arthroscopic interposition arthroplasty of the trapeziometacarpal joint. Chir Main 2011; 30 (04) 282-287
• 17 Pereira A, Ichihara S, Facca S, Hendriks S, Gouzou S, Liverneaux P. Arthroscopic interposition in thumb carpometacarpal osteoarthritis: a series of 26 cases. Chir Main 2015; 34 (06) 307-311
• 18 Dela Rosa TL, Vance MC, Stern PJ. Radiographic optimization of the Eaton classification. J Hand Surg [Br] 2004; 29 (02) 173-177
• 19 Kubik III NJ, Lubahn JD. Intrarater and interrater reliability of the Eaton classification of basal joint arthritis. J Hand Surg Am 2002; 27 (05) 882-885
• 20 Spaans AJ, van Laarhoven CM, Schuurman AH, van Minnen LP. Interobserver agreement of the Eaton-Littler classification system and treatment strategy of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am 2011; 36 (09) 1467-1470
• 21 Wejnold Jorgensen R, Odgaard A, Flensted F, Daugaard H, Hjorth Jensen C. Patient-reported outcomes following interposition arthroplasty of the basal joint of the thumb. J Plast Surg Hand Surg 2020; 55 (02) 105-110
• 22 Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (01) 157-169