Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis

Kriegs-Au, Gabriele; Petje, G.; Fojtl, Eva; Rudolf, G.; Zachs, Ingrid

doi:10.2106/jbjs.d.02630

Cited by 31 publications

(19 citation statements)

References 4 publications

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“…24 Furthermore, other studies have failed to find an association between trapezial space and outcomes. 27,28 Despite these findings, and in agreement with other research, our results indicate that trapeziectomy with LRTI continues to be the dominant surgical procedure.…”

Section: Discussionsupporting

confidence: 91%

Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010

Mahmoudi

Yuan

Lark

et al. 2016

Plastic &Amp; Reconstructive Surgery

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Background Despite equivalent outcomes among surgical treatments of thumb carpometacarpal (CMC) arthritis, little is known about variation in spending. Owing to its complexities, we hypothesized that trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when compared to other surgical procedures incurs the greatest cost to Medicare. Methods Using a random 5% sample of Medicare beneficiaries diagnosed with thumb CMC arthritis, we examined total and out-of-pocket spending for 3,530 patients who underwent a surgical treatment, between 2001 and 2010. We used generalized linear regression models, controlling for patients’ characteristics and place of surgery to examine variation in spending. Results 89% of patients who underwent surgery received trapeziectomy with LRTI, with total and out-of-pocket spending of $2,576 (CI: $2,333 – $2,843, p < 0.001) and $436 (CI: $429 – $531, p < 0.001), respectively. Simple complete trapeziectomy was the least expensive procedure, performed only among 5% of patients, with total and out-of-pocket spending of $1,268 (CI: $1,089 – $1,476, p < 0.001) and $236 (CI: $180 – $258, p < 0.001), respectively. Owing to increasingly higher facility costs, performing the same procedure in a hospital outpatient setting compared with an ambulatory center would increase Medicare spending by more than two folds (p < 0.001). Conclusions With a consistent rise of healthcare spending, adherence to evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with LRTI, the most expensive surgical option. Medicare could potentially save $74 million annually if simple complete trapeziectomy was the procedure of choice.

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Section: Discussionsupporting

confidence: 91%

Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010

Mahmoudi

Yuan

Lark

et al. 2016

Plastic &Amp; Reconstructive Surgery

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“…Since its description in 1983, LRTI has been advocated as a reliable treatment for thumb TM OA producing satisfactory reduction in pain and weakness 3 . Long term studies report “81-95%” satisfactory pain relief 2,4,5 . Despite this, untreated scaphotrapezoid arthritis, thumb metacarpophalangeal joint hyperextension, first web space contracture, instability, pain, deformity, synovitis, or weakness 6 , can necessitate revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Revision Ligament Reconstruction Tendon Interposition for Trapeziometacarpal Arthritis: A Case-Control Investigation

Sadhu

Calfee

Guthrie

et al. 2016

The Journal of Hand Surgery

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Purpose To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared to primary LRTI. Methods This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of two years of follow-up were eligible. All patients completed an in-office study evaluation. Controls (treated only with primary LRTI) were matched from our practice to reach a 1:2 case to control ratio. Outcome measures included Michigan Hand Questionnaire (primary outcome), Quick Disability of the Arm, Hand, and Shoulder (QuickDASH) Questionnaire, VAS for pain and improvement, and physical examination. Statistical analyses were conducted to compare the patient groups. Results Revision LRTI patients reported significantly worse outcomes on all measured standardized questionnaires compared with primary patients. The Michigan Hand Questionnaire indicated worse overall outcomes (54 versus 79) as well as worse pain, appearance, and ability to complete activities of daily living. Revision LRTI patients also reported more impairment (QuickDASH 47 versus 23), greater pain (VAS pain 6.3 versus 1), and less improvement after surgery (VAS improvement 2.7 versus 7.9). There was also a significantly higher rate of patient-reported depression in the revision LRTI group (50% versus 10% of primary LRTI patients). We did not find a significant difference in objective outcomes of pinch strength, grip strength, and thumb palmar abduction between the two groups. Conclusion Following revision LRTI patient-reported outcomes indicate worse perceived function and greater pain than expected following primary LRTI despite similar motion and strength. Revision surgery can be offered in the setting of persistent or recurrent symptoms, but patients should be counseled that improvement of symptoms is unpredictable.

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“…The various surgical techniques applied in the past with variable success and failure rates are, total trapeziectomy,3 ligament reconstruction,4 trapeziectomy with ligament reconstruction with or without tendon interposition,5678 arthrodesis of the joint,9 metacarpal osteotomy10 and arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

Chug

Williams

Benn

et al. 2014

IJOO

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Background:Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.Materials and Methods:We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.Results:There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.Conclusion:The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.

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Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis

Abstract: Tendon interposition does not affect the outcome after the ligament reconstruction for the treatment of osteoarthritis of the thumb carpometacarpal joint. Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome.

Cited by 31 publications

References 4 publications

Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010

Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010

Revision Ligament Reconstruction Tendon Interposition for Trapeziometacarpal Arthritis: A Case-Control Investigation

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

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