High Rate of Treatments Used More Than One Year After Thumb Carpometacarpal Arthritis Surgery: Results From More Than 100 Patients
Imran S. Yousaf, DO, Kavya K Sanghavi, MPH, Aviram M Giladi, MD, MS and Kenneth R. Means, Jr., MD, The Curtis National Hand Center, Baltimore, MD
Introduction: The goal of our study was to determine if thumb carpometacarpal (CMC) arthritis surgery impacts the need for adjunct nonsurgical treatments. We hypothesized that a clinically relevant proportion of patients would continue to use treatments even after recovering from CMC arthritis surgery. We also hypothesized that use of treatments after recovering from surgery would be associated with worse patient-reported outcomes (PROs).
Materials & Methods: We identified patients with thumb CMC arthritis who had isolated primary trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI) at any of our hand center surgery sites and were a minimum 1 year and maximum 4 years post-operative. Patients under 18 years old and those with any other concomitant upper extremity procedures, including associated thumb metacarpophalangeal procedures, were excluded. Participants completed electronic study questionnaires including questions about what treatments they still use after their thumb CMC surgery as well as PROs consisting of the Quick Disability of the Arm, Shoulder, and Hand (qDASH) questionnaire and three different Visual Analog/Numerical Rating Scales (VA/NRS) for pain. We used bivariate linear regression analyses to evaluate the associations between treatment use after recovering from surgery and PROs.
Results: 112 patients met inclusion and exclusion criteria and participated. Median age was 65 years (IQR 61 - 66), with 78 (69%) females. Ninety-two patients (82%) underwent trapeziectomy with LRTI. At a median of three years (IQR 1 - 3) after surgery, more than 40% of all patients reported continued use of at least one treatment (Figure 1). Of those who still used treatments, 29% used splinting, 34% used hand therapy, 4% used corticosteroid injections, 48% used over-the-counter medications (OTC), and 25% used prescription medications. Of these patients, 21% used one and 22% used more than one treatment. 108 of included patients also completed all PROs. Bivariate analyses showed that using any treatment after recovering from surgery was associated with statistically and clinically significantly worse qDASH scores (p<0.05) and VA/NRS scores for current pain (p<0.05), pain with activities (p<0.05), and typical worst pain experienced (p<0.05) (Table 1).
Conclusions: Clinically relevant proportions of patients continue to use several treatments even at a median of three years following primary thumb CMC arthritis surgery. Use of any treatment after recovering from thumb CMC surgery is also associated with clinically and statistically significantly worse post-surgical PROs for function and pain.
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