Outcomes Of Patients Receiving Proximal Row Carpectomy And Meniscus Interposition Allografts For The Treatment Of End-Stage Wrist Arthritis: A Comparative Study
Christopher Ha Pham, MD1; Kylie Tanabe, PA-C2; David Kulber, MD3
1University of Southern California, Los Angeles, CA; 2Cedars-Sinai Medical Center, Los Angeles, CA; 3Division of Plastic and Reconstructive Surgery, Cedars Sinai Medical Center, Los Angeles, CA
Background: When conservative management of metacarpophalangeal (MCP) joint arthritis has been exhausted, MCP arthrodesis and arthroplasty have been shown to be reliable surgical options in treating the pain, deformity, and disability that accompany the joint disorder. Epidemiologic data on these procedures is currently lacking in orthopedic literature. In this database analysis, our objective was to describe the annual volumes and incidence rates of MCP arthrodesis and arthroplasty from 2009 to 2019.
Methods: Patients with MCPJ arthritis who underwent MCPJ arthrodesis or arthroplasty were identified in the Truven MarketScan Database. Patients were identified using common procedural terminology codes. National estimates were determined and adjusted per capita using U.S. national census data.
Results: A total of 26,352 and 23,732 MCP joint arthrodesis and arthroplasty procedures were identified in the database from 2009 to 2019, respectively. Although the annual volumes of MCP arthrodesis did not significantly change over the ten-year period, there was steady period of increase between 2010 and 2018, where arthrodesis procedures rose significantly, from 1,839 to 2,862 annual cases, before decreasing to in 2019. Similarly, procedural incidence significantly increased from 6.1 in 2010 to 8.9 per million, representing a 45.9% change. In comparison, MCPJ arthroplasty volumes slowly declined over the study period, with incidence of MCPJ arthroplasty significantly decreasing 29.9%, from 8.7 per million in 2009 to 6.1 in 2019.
When stratifying by gender, we found that arthrodesis and arthroplasty were performed more commonly in women than in men in both 2009 and 2019. Stratification by age group over the 10-year study period demonstrated stable incidence rates for arthrodesis but significant decreases in arthroplasty among females aged 40-49 and 50-59. Lastly, MCPJ arthrodesis rates remained relatively stable within each region of the U.S. (Northeast, Midwest, South, West). However, MCPJ arthroplasty rates declined in the Northeast, though did not significantly change in other regions across the country.
Conclusion: MCPJ arthrodesis and arthroplasty remain reliable surgical options for MCPJ arthritis. While MCPJ arthroplasty has slowly declined over recent years, MCPJ arthrodesis rates have stayed relatively stable from 2009-2019, though with a period of increase within this. Both procedures are more commonly performed among females, with arthroplasty rates decreasing primarily among women aged 40-49 and 50-59. Further, arthroplasty decline was seen primarily in the Northeast, compared to other regions of the U.S.
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