The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors ...influencing the median time until return to their usual work.
We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression.
In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device.
Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO.
Prognostic IV.
Previous studies indicate that patients with a more negative perception of their illness tend to respond less favorably to treatment, but little is known about whether illness perceptions differ ...based on the type of hand or wrist conditions. Therefore, we compared illness perceptions between patients scheduled to undergo surgery for 4 illnesses in hand surgery: carpometacarpal osteoarthritis (CMC OA), Dupuytren disease, carpal tunnel syndrome (CTS), and trigger finger syndrome (TFS). We hypothesized there would be differences in illness perception between these patient groups.
Before surgery, patients were asked to complete the Brief Illness Perception Questionnaire (Brief-IPQ) as part of routine outcome measurement in a specialized hand and wrist surgery clinic. The Brief-IPQ is a validated questionnaire to rapidly assess the cognitive and emotional representation of illness. Differences in illness perception between the 4 diagnostic groups, corrected for age, sex, hand dominance, and work type, were examined. Cohen D effect sizes were calculated for the between-group differences.
We included 514 patients in the analyses: 87 with CMC OA, 146 with Dupuytren disease, 129 with CTS, and 152 with TFS. On a scale ranging from 0 (most positive perception) to 80 (most negative perception) the Brief-IPQ sum scores for these subgroups were 42.0, 28.2, 38.8, and 33.3, respectively. Corrected for age, sex, hand dominance, and work type, patients with Dupuytren disease had a more positive perception of their illness than patients with CMC OA and CTS. Compared with CMC OA patients, the effect sizes for Dupuytren, CTS, and TFS patients were, respectively, 1.28, 0.32, and 0.81.
In these patients with various hand/wrist disorders, differences were found in their preoperative perceptions of illness. Interventions that directly target negative illness perceptions might improve treatment outcomes for CMC OA and CTS.
These differences should be considered during preoperative medical consultations and/or when investigating surgical outcomes.
This prospective study investigates the extent to which a better experience with healthcare delivery is associated with better postoperative treatment outcomes after surgery for Dupuytren’s ...contracture. Patients undergoing limited fasciectomy or percutaneous needle fasciotomy for Dupuytren’s contractures completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery, together with a patient reported experience measure, while hand therapists assessed the straightness of the finger with a goniometer. Regression analyses were used to examine associations. We found that a better experience with healthcare delivery was associated with better patient-reported outcomes, while association with residual extension deficit was minimal. Strongest associations were seen with communication of the physician, postoperative care and information about the treatment. Experience with the treatment explained up to 12% of the variance in treatment outcome. These findings suggest that patient reported treatment outcomes in Dupuytren’s disease can be improved by improving the treatment context.
Level of evidence: II
Background
Avascular necrosis of the lunate has been the topic of debate for the last century. A relatively new treatment for a symptomatic patient with a Lichtman stage IIIB or stage IV is lunate ...pyrocarbon implant arthroplasty. The purpose of this study is to document the clinical outcomes and evaluate the results of this new modality.
Methods
A retrospective cohort study of patients with a symptomatic Kienböck’s disease stage IIIB treated by lunate pyrocarbon implant arthroplasty stabilized with a tendon graft. Presurgical and postsurgical assessment was performed including a questionnaire, X-ray, goniometric measurements, and grip strength.
Results
Between 2010 and 2013, 16 patients with a mean follow-up of 24 months were treated. Average VAS score improved from 5 to 2.6 and average PRHWE score from 58 to 24. The average flexion extension arc and wrist deviation arc were decreased 26 and 14 degrees. The average grip strength increased from 23 to 29. Most patients were very satisfied about the operation; 14 out of 16 would undergo the same procedure again, given the same circumstances.
Conclusions
Both the subjective and objective results are comparable to previous reported data of conventional treatments, and it may therefore be a suitable alternative to proximal row carpectomy (PRC). The implant lifespan is not known, but it could postpone the need for salvage procedures in young patients. Further research is needed to provide long-term outcomes and help guide future treatment of patients with Kienböck’s disease.
Level of evidence: Level IV, therapeutic study.
This study investigates the outcomes of 1106 patients with Dupuytren’s disease treated with limited fasciectomy or percutaneous needle fasciotomy over 16 years according to the different domains of ...patient-reported hand function. These patients completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery. Scores for the various outcome parameters were calculated and linear regression analyses were used to examine associations between the changes in digital extension deficit and change in Michigan Hand Outcomes Questionnaire (sub)scores. We found the largest effects of surgical treatment in the decreases in extension deficit, the appearance of the hand, and the satisfaction with the hand function. However, associations between different domains of evaluation were weak. We conclude that improvement of digital extension deficits is not parallel to varying aspects of patient satisfaction. The findings underline the importance of assessing domains relating to patient satisfaction other than objective hand function measures in Dupuytren’s disease.
Level of evidence: IV
The aim of this study was to investigate the association between patients’ experiences with trapeziometacarpal arthroplasty and treatment outcomes in terms of patient-reported outcome measures, grip ...and pinch strength. We included 233 patients who received a Weilby procedure for trapeziometacarpal osteoarthritis. Before surgery and 12 months after surgery, patients completed the Michigan Hand Outcomes Questionnaire, and their pinch and grip strengths were measured. At 3 months after surgery, a patient-reported experience measure was completed. Using regression analysis, significantly positive associations were found between the Michigan Hand questionnaire and the patient-reported experience measure, with the strongest significant associations being for patients’ experiences with information provision. No significant associations were found between the patients’ experience and strength outcomes. The results highlight the potential importance of positive experience with the treatment process to improve treatment outcomes in patients undergoing surgery for trapeziometacarpal osteoarthritis.
Level of evidence: IV
In this cohort study, we report on short-term outcomes of 203 patients (203 wrists) who underwent scapholunate ligament reconstruction using a three-ligament tenodesis technique between December 2013 ...and December 2017. Patients completed the Patient Rated Wrist Evaluation questionnaire and a visual analogue scale for pain online before surgery and at 3 months and 1 year after surgery. We also measured the range of movement before surgery, in 150 patients 3 months after surgery, and in 90 patients 1 year after surgery. The patients reported clinically significant improvements in both pain and function postoperatively, with continuing improvement at both 3 and 12 months. We conclude that the short-term outcomes of this procedure are generally good in term of patients’ function, satisfaction, and pain relief, but about 20% of the operated wrists did not improve. Our data may help patients and surgeons in joint decision-making regarding treatment for chronic scapholunate injuries.
Level of evidence: III
Routine outcome measurements as a critical prerequisite of value-based healthcare have received considerable attention recently. There has been less attention for the last step in value-based ...healthcare where measurement of outcomes also leads to improvement in the quality of care. This is probably not without reason, since the last part of the learning cycle: ‘Closing the loop’, seems the hardest to implement. The journey from measuring outcomes to changing daily care can be troublesome. As early adopters of value-based healthcare, we would like to share our 10 years of experience in this journey. Examples of feedback loops are shown based on outcome measurements implemented to improve our daily care process as a focused hand surgery and hand therapy clinic. Feedback loops can be used to improve shared decision making, to monitor or predict treatment progression over time, for extreme value detection, improve journal clubs, and surgeon evaluation. Our goal as surgeons to improve treatment should not stop at the act of implementing routine outcome measurements. We should implement routine analysis and routine feedback loops, because real-time performance feedback can accelerate our learning cycle.
Cite this article: EFORT Open Rev 2021;6:439-450. DOI: 10.1302/2058-5241.6.210012
Objective: Research on carpometacarpal (CMC) osteoarthritis (OA) is primarily focused on comparing surgical outcome of different techniques, in case series or comparative studies. Many studies do not ...demonstrate significant differences in outcome between surgical techniques. However, it has been reported that a relatively large part of treated patients have significant residual pain and functional limitations, or even deterioration of their initial complaints. Overall outcome may also be improved by selecting “the right patients” for surgical treatment. Therefore, the aim of this study is to (1) describe the outcome of widely used techniques for CMC OA in a large, multicenter cohort and (2) identify predictive factors of poor surgical outcome, defined in terms of pain, complications, hand function, and patient satisfaction to predict possible failure after surgical treatment. Materials and Methods: We included 668 patients in a multicenter, prospective study between 2011 and 2015, who were surgically treated for CMC OA with trapeziectomy with ligament reconstruction and tendon interposition (LRTI).Outcome parameters, registered preoperatively, 3 months and 12 months after surgery, included pain (visual analogue scale VAS), function (Michigan Hand Questionnaire MHQ), complications, and satisfaction with the hand. Postoperative outcomes were compared with baseline levels. Multiple imputation was performed after missing value analysis. Baseline pain, function and strength, sociodemographics, and hand surgical history were analyzed as possible predictors for outcome after surgery, by multivariate regression analysis. Results: For all measurements, outcomes improved significantly after surgery, with effect sizes greater than 0.8 for pain, total MHQ score, and patient satisfaction outcomes. However, we found a residual rest pain of 19 (VAS 0-100) after 1 year. In total, there were 327 complications in 229 patients, of which 43% required no or conservative treatment. Univariate analysis showed that only a few of the baseline variables correlated with postoperative outcome measurements at 12 months. These associated variables were combined with predictors selected from literature and were considered in multivariable analyses. For pain and the number of complications, the multivariable regression models could only explain 2% of the variance in the model. For self-reported satisfaction of the hand, this was only 5%. For the MHQ score, the multivariable regression analysis could explain 17% of the variance in the model, with a history of De Quervain tendinitis, smoking, lower baseline MHQ total score, and increased preoperative pain, independently predicting a worse postoperative MHQ score. Conclusions: After surgical treatment for CMC OA, improvements in pain, strength, and function in our study are highly significant and clinically relevant. Despite the large overall improvement, we found significant percentages of patients with unfavorable outcomes (residual pain and functional deficits) in this large cohort, which is also in line with present literature. Based on this study, we conclude that we cannot predict which patients will have bad surgical results after surgical treatment for thumb CMC OA, despite our relatively large sample of baseline characteristics and large cohort. Our study suggests that we need to look beyond the commonly evaluated predictive factors (age, gender, baseline functional scores, etc) and treatment algorithms to improve outcome of all patients with CMC OA.
Objective: High surgeon procedural volume has been linked to better outcomes for a variety of surgical procedures, but the impact of surgeon volume on outcomes of Dupuytren surgery remains uncertain. ...Materials and Methods: We used data from a quality-of-care registry from 6 hand surgery practice sites between 2011 and 2014. We included 561 patients with the Dupuytren disease who underwent fasciectomy (71%) or percutaneous needle fasciotomy (29%) by 16 hand surgeons. Outcomes were the degree of residual contracture and adverse events assessed at 6 to 12 weeks after treatment. Relations between volume and outcomes were examined using linear and logistic regression models, with adjustment for patient characteristics and the type of procedure. Nonlinearity was assessed with restricted cubic splines. Results: Overall, mean residual contracture (total active extension deficit) at follow-up was 24°, which corresponded to a postprocedure improvement of 65%. Forty-seven percent of patients experienced at least 1 adverse event, with neuropraxia (12%), scar sequelae (12%), and wound healing problems (8%) being the three most common events. Surgeon volume was inversely related to the degree of residual contracture: Every 58 additional procedures performed annually were associated with 5° less residual contracture at follow-up (P, .03). Moreover, surgeon volume had an inverse effect on overall events (odds ratio per 50 additional procedures, 0.86, P, .01). Conclusions: Even among experienced hand surgeons, patients treated by surgeons performing high volumes of Dupuytren surgery had better outcomes in terms of residual contracture and adverse events. The findings of this study suggest that surgeons may improve outcomes by increasing their annual procedural volume for these specific interventions.
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