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Patient Satisfaction after Bilateral Thumb Carpal Metacarpal Osteoarthritis Surgery
Arnold B. Alqueza, MD; Fostvedt Sigrid, BA; Jesse B. Jupiter, MD
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA

Purpose: This study determines whether the initial unilateral surgery relieves pain sufficiently that the patient seeks the same procedure for the contralateral side and/or recommend the procedure to others with similar symptoms.  Our hypothesis: pain relief is inadequate postoperatively that patients elect not to undergo similar surgery on the contralateral side.

Methods: Retrospective review of patients at our Institution was conducted after IRB approval for the period between 1995 to 2010.  48 Patients met the criteria of bilateral thumb CMC OA and having had some surgical intervention mostly consisting of trapeziectomy, ligament reconstruction with tendon interposition.  2 patients were deceased.  All surgeries were performed by senior author.  Patients were evaluated using the DASH and the Enneking Musculoskeletal Score for Upper Extremity Lesions affecting the upper limb.  41/46 Enrolled.

Results: The average DASH score was 17.3 (range, 0 to 75). The average Enneking Musculoskeletal Score was 88.21 (range, 33.3 to 100).  Regarding emotional acceptance in the Enneking Score, one of 41 patients rated it a 0 (0-5) that they disliked the surgery and would not doing the surgery again.  Three of the 41 rated it a 1 that they accept the outcome and would have surgery again or would not do it again if there were another option.  One of 41 rated emotional acceptance as a 3, that person is satisfied with outcome and would do surgery again. Three of 41 rated emotional acceptance as 4; they like their outcome and would do it again.  The rest of the cohort (33 of 41) were enthused with their outcome and would recommend it to others with the same problem. 

Bivariate Analysis shows that perceived health correlated with DASH scores (p=0.003) and that number of other pain conditions also correlated (p=0.021).  The same analysis showed that age at followup and perceived health correlated with the Enneking Functional Evaluation System (p = 0.018 and p = 0.005, respectively)

The Enneking Functional Evaluation Systems rates on  categories: Pain, Function, Emotional Acceptance, Hand Positioning, Dexterity and Lifting Ability.  All categories correlated with the DASH except for Emotional Acceptance (p=0.227).

Conclusion: At an average follow-up of 44.9 months, most patients are happy having had bilateral thumb carpal metacarpal surgery for osteoarthritis. By virtue of consenting for the second surgery, the outcome of the first surgery was acceptable enough to seek similar surgery on the contralateral thumb for similar symptoms. This study supported that trend.

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