Recurrence of Dupuytren’s contracture: A consensus-based definition

Kan, Hester J.; Verrijp, Frank W.; Hovius, Steven E.R.; Nieuwenhoven, Christianne A. van; Selles, Ruud W.

doi:10.1371/journal.pone.0164849

Cited by 51 publications

(44 citation statements)

References 19 publications

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“…However, this information is valuable to patients and policymakers, as such serious complications are likely to have a more major effect on quality of life, and lead to increased healthcare costs. Similarly, our definition of re-operation on the same hand is not identical to the recently agreed consensus for a definition of recurrence 22 . It is possible that some re-operations were for extension of disease to another finger, and that patients with true recurrence decided to not have repeat surgery.…”

Section: Discussionmentioning

confidence: 70%

Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

Alser

Craig

Lane

et al. 2020

Sci Rep

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Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.

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Section: Discussionmentioning

confidence: 70%

Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

Alser

Craig

Lane

et al. 2020

Sci Rep

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“…Since these studies can provide useful information for health care providers and enhance health and therapeutic interventions to improve the quality of services. Ultimately these could lead to improving the quality of life of the patients [ 81 – 83 ].…”

Section: Discussionmentioning

confidence: 99%

The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis

et al. 2020

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Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.

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“…Furthermore, the literature lacks a clear universal definition of disease recurrence and what constitutes a clinically relevant difference in total extension deficit, although an expert group recently reached a consensus that recurrence should be defined as more than 20° of contracture recurrence in any treated joint at 1 year post-treatment (or later) compared with 6 weeks post-treatment. 38 This in turn may affect the sample size calculation. We base our calculation on a clinically relevant difference of 20° since it has been used most frequently in recent studies of collagenase treatment 18 19 and is supported by the expert group.…”

Section: Discussionmentioning

confidence: 99%

“…We base our calculation on a clinically relevant difference of 20° since it has been used most frequently in recent studies of collagenase treatment 18 19 and is supported by the expert group. 38 Another limitation is the use of PROMs in research on DD. Although the QuickDASH score, a measure of activity limitations related to upper-extremity disorders, is commonly used in hand surgery research, it may not be sensitive to changes in DD-related contractures.…”

Section: Discussionmentioning

confidence: 99%

“…There is no universal definition of recurrence of DD in the literature, although an expert group recently reached a consensus that recurrence should be defined as more than 20° of contracture recurrence in any treated joint at 1 year (or later) post-treatment compared with 6 weeks post-treatment. 38 In this study, we assume that surgical fasciectomy is more effective in reducing recurrent contractures and that a difference of 20° in total extension is considered clinically relevant. 18 A previous study has shown that patients treated with collagenase injection for recurrence after surgical fasciectomy had a mean improvement of 43° (SD 28) in total extension deficit.…”

Section: Methods and Analysismentioning

confidence: 99%

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Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial

et al. 2019

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IntroductionThere is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common. Surgical fasciectomy is considered the standard treatment method for recurrence, although associated with a high incidence of complications. Collagenase injection, a non-surgical treatment option, has been shown to be a safe and effective method; however, most studies regarding collagenase have involved first-time treatment. Collagenase efficacy in patients with recurrent DD beyond the immediate effect has not yet been determined. The aim of our study is to compare surgical fasciectomy and collagenase injection in treating recurrent DD.Methods and analysisThe study is a single-centre randomised controlled trial. Inclusion criteria are recurrence of DD in one or more fingers after previous treatment with fasciectomy or collagenase injection, a passive extension deficit ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint, and a palpable cord causing the recurrent contracture. A total of 56 patients will be randomised to either surgical fasciectomy or collagenase injection. A hand therapist blinded to patients’ group allocation will measure range of motion at baseline, 3 months, 12 months, 24 months and 60 months. The primary outcomes are the total active extension deficit (MCP plus PIP) at 3 months and the proportion of patients with contracture worsening ≥20° in the treated finger joint at 2 years compared with 3 months. The secondary outcomes include changes in total active motion, active and passive extension deficit from baseline up to 5 years, scores on patient-reported outcome measures, adverse events and costs of treatment.Ethics and disseminationEthical approval has been obtained from the Regional Ethical Review Board, Lund University, Sweden(2017/623). The trial will be conducted according to the Helsinki Declaration of 1975, revised in 2000. The results of the trial will be disseminated as published articles in peer-reviewed journals.Trial registrationNCT03406338; Pre-results.

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Recurrence of Dupuytren’s contracture: A consensus-based definition

Cited by 51 publications

References 19 publications

Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis

Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial

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