Dupuytren's contracture: an analysis of outcomes of percutaneous needle fasciotomy versus open fasciectomy

Toppi, Jason; Trompf, Leisel; Smoll, Nicolas R.; Lim, Vivian; Smith, Katrina; Findlay, Michael W.; Hunter-Smith, David J.

doi:10.1111/ans.12513

Cited by 21 publications

(22 citation statements)

References 18 publications

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“…71,72 Of the surgery non-randomised studies, one was conducted in several countries, 73 one in the UK, 74 one in Brazil, 57 one in the USA 75 and one in Australia. 76 Nine of the collagenase case series were conducted in the USA 48,77,81,83,[85][86][87][88][89] two in Australia, 78,79 one in the UK, 91 one in Spain, 84 one in several countries, 90 and the remaining one did not report this information. 63 The non-randomised studies comparing collagenase with surgery enrolled and analysed a total of 105 participants.…”

Section: Assessment Of Clinical Effectivenessmentioning

confidence: 99%

“…The two non-randomised studies comparing collagenase with surgery 71,72 and the five non-randomised studies comparing various surgical procedures 44,57,[73][74][75][76] were published in full. Three studies collected data prospectively 72,74,75 and three retrospectively.…”

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confidence: 99%

“…Three studies collected data prospectively 72,74,75 and three retrospectively. 71,73,76 One study did not report this information. …”

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Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Assessment Of Clinical Effectivenessmentioning

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Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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“…The functional outcomes have usually been documented through physical measurements and through patient-reported outcome questionnaires [17]. Patient satisfaction with the outcome or with the treatment for DD, evaluated with different methods has also been reported in several studies [17,[20][21][22][23][24][25]. However, previous research has concluded that patient satisfaction is a multidimensional concept that can be difficult to capture [26][27][28][29][30], and that it is associated with structure and process aspects of care [28].…”

Section: Introductionmentioning

confidence: 99%

Patients’ perspective on surgical intervention for Dupuytren’s disease – experiences, expectations and appraisal of results

Engstrand

Kvist

Krevers

2016

Disability and Rehabilitation

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PurposeTo explore patients' perspectives on surgical intervention for Dupuytren's disease, focusing on patients' appraisal of results, involving previous experiences, expectations, and patient characters. MethodThe participants were twenty-one men, mean age 66 years, scheduled for Dupuytren's disease surgery. Qualitative interviews were conducted two-four weeks before, and six-eight months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data was analysed using problem-driven content analysis. ResultsFive categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants' expectations, and these were used along with other aspects as references for appraisal of results. Participants' appraisal of results concerned perceived changes in hand function, care process, competency and organisation, and could vary in relation to patient character. The appraisal of results influenced participants' expectations of future hand function, health and care. ConclusionsPatients' appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate 2 results after Dupuytren's disease surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.3

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“…the development of new DD tissue in the operated area (1). Despite possible drawbacks of surgery, several studies report high overall patient satisfaction or satisfaction with the procedure (15,17,(20)(21)(22)(23)(24). After fasciectomy, patients also report improved quality of life (25).…”

Section: Introductionmentioning

confidence: 99%

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

Engstrand¹,

Krevers²,

Nylander³

et al. 2014

The Journal of Hand Surgery

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PurposeTo describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. MethodsThis prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60 degrees or more from Dupuytren contracture were included. Outcomes measures were range of motion, sensibility, scar pliability, self-reported outcomes on expectations, recovery, and satisfaction with hand function, Disabilities of the Arm, Shoulder, and Hand scores, safety and social issues of hand function, physical activity habits, and quality of life with the Euroqol. ResultsThe extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months 32% considered hand function as fully recovered, and 73%were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder and Hand score and the Euroqol improved over time. 2 ConclusionAfter surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

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Dupuytren's contracture: an analysis of outcomes of percutaneous needle fasciotomy versus open fasciectomy

Cited by 21 publications

References 18 publications

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Patients’ perspective on surgical intervention for Dupuytren’s disease – experiences, expectations and appraisal of results

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

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