Death, Taxes, and Trapeziometacarpal Arthrosis

Abstract

Background Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which-it seems safe to assume-most people never seek medical attention. Questions/purposes The aims of our study were (1) to confirm the prevalence of radiographic trapeziometacarpal arthrosis in a very large sample and to determine if age and sex are associated with (2) any radiographic evidence of trapeziometacarpal arthrosis; and (3) radiographic evidence of severe trapeziometacarpal arthrosis.Methods A total of 2321 patients 31 years or older with radiographs obtained during treatment of a distal radius fracture at a tertiary care medical center emergency department between 2002 and 2012 were analyzed. Trapeziometacarpal arthrosis was graded using the 3-point scale of Sodha et al. (none, definite, destroyed trapeziometacarpal joint); we used regression analyses to determine the association of age (in 10-year age groups) and sex with the presence of trapeziometacarpal arthrosis. Results The prevalence of trapeziometacarpal arthrosis steadily increased to 85% between the ages of 71 and 80 years and reached 100% in women (with 50% of them being classified as severe) aged 91 years or older and 93% in men of 81 years or older. Severe arthrosis was more prevalent at earlier ages among women and reached 35% in women and 34% in men who were 81 years or older. Logistic regression identified higher age as the strongest factor associated with trapeziometacarpal arthrosis, but sex was also a factor.

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

“…Female sex and older age are associated with greater pathophysiology [3,19], but patients who saw additional providers and who were younger were associated with greater costs and greater likelihood of surgery; the latter also increased in male patients. With our large cohort of patients, those with less severe disease used more extensive medical services.…”

“…Another study found that women are more willing to delay surgery to await better technology and avoid disrupting of their caregiver roles [12]. The high prevalence of hand OA that occurs with increasing age suggests that most people adapt to it [3,5]. Delaying surgery, something that may come more naturally to women might prevent surgery altogether.…”

Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis

“…High compressive forces through the CMC joint, up to 120 kg with power grasp and 12 kg with tip pinch [8], may predispose this joint to degenerative arthritis. Arthritis of this joint more commonly occurs in women than in men, starting in middle adulthood and increasing in prevalence with age [14]; radiographic prevalence ranging from 33% of postmenopausal women [1] to as high as 100% of women older than 91 years is described [4]. The anterior oblique ligament incompetence has been shown to play a role in the progression of CMC arthritis [3,7,19,20].…”

“…Although Eaton and Littler described their radiographic classification to be used to guide surgical intervention [12], the radiographic presence of basilar thumb arthritis is nearly inevitable with age [4], and surgery should be considered only if extensive nonsurgical treatment options have been exhausted and lifestyle limiting pain and disability persists.…”

Editor’s Spotlight/Take 5: The 2014 ABJS Nicolas Andry Award: The Puzzle of the Thumb: Mobility, Stability, and Demands in Opposition

“…In fact, the symposium explored a broad range of clinical and laboratory research, and some very interesting history on the topic [4]. When we combine this excellent symposium with the epidemiology research that extended our understanding of this joint to the final decades of life [1], and place them alongside this award-winning study, it becomes clear that this has been a very good year at CORR 1 in terms of what we have learned about this complex joint.…”