Metacarpophalangeal arthroplasty from the patient's perspective

Abstract

ABSTRACT:The results of metacarpophalangeal (MCP) arthroplasty have been measured by objective measures and, to a lesser extent, subjective measures. The aim of this study was to understand patients' goals for MCP arthroplasty and the changes that occurred for them after surgery. Twenty of 24 patients reported that their MCP arthroplasty was successful because their function, pain, or hand appearance improved after the surgery. Functional changes related to how an activity was performed rather than new abilities being enabled by the surgery. There are many qualities to changes in pain and function, which closedended questions would not capture. Patients may not have attempted all normal activities within the first four postoperative months; therefore, functional outcomes must be measured after four months. Concurrent surgical, pharmaceutical, and therapy interventions also change patients' function, making the exact effects of the MCP arthroplasty unclear. J HAND THER. 2003;16:315-319.

Hand Appearance as a Patient Motivation for Surgery and a Determinant of Satisfaction with Metacarpophalangeal Joint Arthroplasty for Rheumatoid Arthritis

“…Two studies addressed patients' perspectives after their surgery. In a survey of 22 patients who had MCP joint arthroplasty a mean of 5 years earlier, 1 and in semistructured interviews with 24 patients who had MCP joint reconstruction 4 months to 4 years earlier, 3 improved hand function was the most important motivator for surgery, followed by improved hand appearance and pain relief, which were approximately equal. We interpret these results to mean that appearance is probably a key motivator for surgery.…”

“…Two retrospective studies of patients with RA who had MCP joint arthroplasty found only 8 of 25 patients and 11 of 24 patients expected pain relief following surgery. 2,3 This might be because numerous patients with severe RA who choose MCP joint reconstruction have little or no pain. 11 Patient satisfaction 1 year following MCP joint arthroplasty was high across all 3 domains of function, appearance, and pain in this study, and no single domain was found to be driving overall satisfaction.…”

“…Six studies addressing patient motivators for hand surgery have reported mixed outcomes. [1][2][3][4][5][6] A retrospective study of 22 patients with RA who had MCP joint reconstruction for all 4 digits in the hand a mean of 5 years earlier found that improvement in hand appearance was as strong a motivator for surgery as pain relief but less strong than improvement in hand function. 1 Another retrospective evaluation of 25 patients with RA who had arthroplasty of the MCP joint in most digits of 29 hands 2.5 years earlier reported that 19 patients expected the surgery to improve hand appearance, whereas 12 expected improved function, and only 8 expected pain relief.…”

“…2 Retrospective semistructured interviews with 24 patients who had MCP arthroplasty 4 months to 4 years earlier found that improved function was the most common reason for having surgery, given by 22 patients, compared to improved appearance by 13 and pain relief by 11. 3 More recently, 3 studies have prospectively explored motivators for MCP joint arthroplasty. 4 -6 In 117 patients diagnosed with RA who had not yet committed to having surgery, 41 of whom described themselves as having severe disease, function or pain was ranked as the primary hand concern.…”

“…[1][2][3][4][5][6] It remains unclear whether appearance of the hand is an important motivating factor and an important determinant of satisfaction for patients with rheumatoid arthritis (RA) having metacarpophalangeal (MCP) joint arthroplasty. This study was designed to clarify the importance of the appearance of the hand to patients.…”