J Wrist Surg 2021; 10(06): 502-510
DOI: 10.1055/s-0041-1728806
Scientific Article

Joint Distraction for Thumb Carpometacarpal Osteoarthritis: 2-Year Follow-up Results of 20 Patients

1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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2   Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands.
,
3   Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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4   Department of Plastic Surgery, Royal Adelaide Hospital, Adelaide, Australia
,
1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
5   Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
› Author Affiliations
Funding This study was financially supported by the Dutch Arthritis Foundation on 14-01-2013 to perform MRI in five patients.

Abstract

Background Joint distraction is a fairly new treatment for patients with symptomatic thumb carpometacarpal osteoarthritis (CMC1 OA). A previous pilot study of five patients showed that CMC1 joint distraction is technically feasible. The current study presents the results of CMC1 joint distraction in 20 patients with a 2-year follow-up period.

Purposes The primary study aim was to assess if patients with CMC1 OA have better physical function and less pain 2 years after CMC1 joint distraction. Second, we assessed the number of patients who achieved a minimal clinically important difference (MCID) in patient-reported outcome measures at each follow-up time point. Furthermore, this study sought differences on magnetic resonance imaging (MRI) of the CMC1 joint before and after distraction. Adverse events were noted and reported.

Methods Twenty patients (median age of 54 years) with symptomatic CMC1 OA and an established indication for a trapeziectomy were enrolled. An external distractor device was placed over the CMC1 joint and left in situ for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), visual analogue scale (VAS), and grip strength were recorded preoperatively and at 3, 6, 12, and 24 months postoperatively.

Results Two years after joint distraction, physical function and pain scores had improved significantly compared with baseline: DASH from 48 to 17, MHQ from 56 to 83, and VAS for pain from 50 to 18 mm. Fourteen of 19 patients (74%) reached an MCID in DASH and MHQ scores. One patient was not satisfied with treatment outcome and chose to proceed with a trapeziectomy 14 months after initial distraction therapy.

Conclusions This study demonstrates that CMC1 joint distraction can postpone more invasive surgical interventions (e.g., trapeziectomy) for at least 2 years. Larger comparative studies are needed to assess the value of CMC1 joint distraction in the treatment of CMC1 OA.

Level of Evidence This is a Level IV, prospective case series study.

Note

The work was performed at St. Antonius Hospital, Nieuwegein, the Netherlands.


Ethical Approval

This study received approval from the local institutional review board (Medical research Ethics Committees United; MEC-U) of the St. Antonius Hospital, Nieuwegein, the Netherlands. This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study has been performed in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Written informed consent was obtained from all 20 patients before the study.




Publication History

Received: 30 October 2020

Accepted: 10 March 2021

Article published online:
04 May 2021

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