Factors affecting return to work after surgical treatment of trapeziometacarpal joint osteoarthritis

This study aimed to identify factors contributing to the timing of return to work after surgical treatment of trapeziometacarpal joint osteoarthritis and to calculate the costs of lost productivity. We included 627 patients with paid employment who underwent trapeziectomy and ligament reconstruction with tendon interposition. Time to return to work was measured through filling online questionnaires and analysed using survival analysis at 6 weeks and 3, 6 and 12 months after the surgery. Patients also filled in the Michigan Hand Outcomes Questionnaire. Costs of lost productivity were calculated using the human capital method. After 1 year, 78% of the patients returned to work. The median time to return to work was 12 weeks. Factors that significantly affected the time to return to work were occupational intensity (light, moderate or heavy physical labour), whether the dominant hand was treated and the Michigan Hand Outcomes Questionnaire work score and hand function score of the unoperated side at baseline. The costs of lost productivity were estimated at €11,000 on the patient level, resulting in €16.8 million on the Dutch population level per year. Level of evidence: II

Autologous fat transplantation for the treatment of trapeziometacarpal joint osteoarthritis

Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.

Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97–144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure. Level of evidence: IV

A health utility assessment of trapeziectomy with ligament reconstruction and tendon interposition for thumb trapeziometacarpal osteoarthritis

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal joint osteoarthritis may have both postoperative benefits and complications. This study sought to determine the health state utility outcome measures of trapeziectomy with LRTI. Patients who underwent trapeziectomy with LRTI were invited to complete the brief Michigan Hand Questionnaire and utility questionnaires outcomes using a visual analogue scale , time trade-off and standard gamble. Quality-adjusted life years (QALYs) were derived from these utility measures. For this study 32 patients were recruited, with a mean age of 61. Most patients (27/32) perceived the procedure as successful. Utility measures and QALYs serve the purpose of comparing different surgical procedures in terms of their impact on the quality of life of patients as a function of the benefits and complications of each procedure. In this study, the utility of trapeziectomy with LRTI was less than has been described for open palmar fasciectomy but more than for total wrist arthrodesis. Level of evidence: IV

Ivory arthroplasty for trapeziometacarpal osteoarthritis: 10-year follow-up

This prospective study investigates long-term functional outcome after total trapeziometacarpal joint replacement with the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis. Clinical outcome, overall function, pain, and radiologic outcome after a minimum of 10 years were evaluated for 26 Ivory arthroplasty in 24 patients. Two patients had bilateral arthroplasties. The female to male ratio was 22:2, and the mean age was 71 years (range 57–83). The mean follow-up period was 130 months (range 120–142). Overall functioning as defined by the QuickDASH score and visual analogue pain score improved by 50% and 81%, respectively, when compared with the preoperative status. However, these outcomes deteriorated beyond 5 years after surgery. Long-term results suggest the Ivory arthroplasty to be a reliable treatment for trapeziometacarpal osteoarthritis since it improves overall function and reduces pain up to 10 years postoperatively. However, revision within 10 years after surgery was needed in four of 26 cases. Level of evidence: II