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Patient Expectations for Pain Relief after Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Osteoarthritis
Cameron Wallace, MD
1, Gretchen Maughan-Egbert, MSPH
1, Abigail Larson, BS
1, Jesse Williams, BS
2, Miranda J. Rogers, MD, MS
3; Nikolas H. Kazmers, MD, MSE
1(1)University of Utah, Salt Lake City, UT, (2)University of Utah, SLC, UT, (3)University of Michigan, Ann Arbor, MI
Introduction: Understanding patient expectations is an important piece in delivering care when it comes to managing chronic health conditions, such as thumb carpometacarpal osteoarthritis (CMC1OA). As a part of patient counseling, striving to describe and communicate realistic and achievable expectations with patients has potential to improve patient satisfaction by aligning their expectations and outcomes. Unfortunately, little is known about what patients expect regarding outcomes following ligament reconstruction and tendon interposition (LRTI). The aim of this study was to define the expectations of patients undergoing LRTI for CMC1OA in order to improve pre-operative counseling.
Materials & Methods: Patients who underwent LRTI between August 2014 and September 2024 at a single tertiary care center were identified using CPT codes 25447 and 25210. Patients who had completed expectations questionnaires within 15 weeks prior to surgery, as well as questionnaires about pain relief postoperatively, were included. A retrospective review was performed to identity and exclude patients with concurrent surgeries (other than carpal tunnel release, trigger digit release, and/or thumb MP procedures), other upper extremity conditions, or revision surgery. The first of two surgeries for patients who underwent staged bilateral LRTI was eligible for inclusion. Demographics, patient preoperative expectations, patient-reported pain relief, and QuickDASH were collected.
Results: A total of 99 patients were included in analysis with an average age of 62.7±8.6 years. Most patients were female (75/99, 75.8%) and white (92/99, 93%). Preoperatively, 66% of patients expected ‘great' pain relief and 20% ‘some' pain relief. At a mean of 11.2±2.5 weeks postoperatively, mean QuickDASH was 32, with 38% of patients experiencing ‘great relief' and 48% experiencing ‘some relief'.
Conclusions: The majority of patients expected ‘great relief' in pain from LRTI surgery, however, most patients instead experienced ‘some relief'. Though a smaller portion of patients experienced ‘great relief' than they expected, 85% of patients achieved either ‘great relief' or ‘good relief' with only 6% noticing ‘little' or ‘no relief'. While 12 weeks postoperatively is relatively short follow-up, a nadir in VAS-pain scores has been demonstrated in LRTI patients in this time frame with no further clinically- or statistically significant improvement. The mismatch between expectation and outcome may lead to dissatisfaction for some patients, highlighting an opportunity for more refined expectation-setting pre-operatively by the treating surgeon.
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