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Koenuma N, Ikari K, Oh K, Iwakura N, Okazaki K. Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis. J Hand Surg Am 2024; 49:443-449. [PMID: 38402479 DOI: 10.1016/j.jhsa.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/31/2023] [Accepted: 01/17/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE The primary objective of this study was to compare the long-term survival rates of silicone metacarpophalangeal (MCP) arthroplasties between two major implants in patients with rheumatoid arthritis, using implant fracture as an end point. We also evaluated the difference in postoperative function between patients with fractured and intact implants as a secondary objective. METHODS A retrospective cohort study was conducted on 372 fingers of 133 hands that underwent silicone MCP arthroplasty between January 2000 and June 2019 (mean follow-up, 7.6 years). The survival rates of Swanson-type and Sutter-type implants were compared, using implant fracture as the end point after a radiographic evaluation. Clinical measures and upper limb functional assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) score were performed in the nested cohort. RESULTS The 10.6-year survival rates for implant fracture of Swanson- and Sutter-type implants were 86.2% and 9.4%, respectively, with significantly higher survival noted for Swanson-type implants. The Sutter-type implant showed increased susceptibility to fracture in all four fingers compared to the Swanson-type implant. Implant fractures were primarily observed at the stem-hinge junction. There were no significant differences in upper limb function between the fractured and intact implant groups. CONCLUSIONS Sutter-type implants were found to be more prone to fracture compared with Swanson-type implants. However, implant fractures did not significantly affect upper limb function. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis IV.
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Affiliation(s)
- Naoko Koenuma
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Koei Oh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Nahoko Iwakura
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Jia Q, Peng Z, Huang A, Jiang S, Zhao W, Xie Z, Ma C. Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation. J Orthop Surg Res 2024; 19:231. [PMID: 38589910 PMCID: PMC11000308 DOI: 10.1186/s13018-024-04655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.
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Affiliation(s)
- Qiyu Jia
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenlei Peng
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anqi Huang
- Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Child Mental Health Research Center, Nanjing University, Nanjing, China
| | - Shijie Jiang
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wen Zhao
- Department of Orthopedics, Beijing Aerospace General Hospital, Beijing, China.
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Zengru Xie
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Ayache A, Spies CK, Unglaub F. [Arthroplasty of the hand and wrist]. Z Rheumatol 2023; 82:839-851. [PMID: 37828110 DOI: 10.1007/s00393-023-01420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 10/14/2023]
Abstract
Arthrosis and autoimmune arthritis frequently lead to major impairment of hand function. Primary therapy consists of well- tried conservative treatments and joint preserving surgical options for special indications. In advanced stages silicon spacers remain the gold standard surgical option for replacement of proximal interphalangeal and metacarpophalgeal joints of the fingers. Alternatively, surface replacement prostheses can restore the biomechanical properties of these joints more porperly. In case of the carpometacarpal (CMC) joint of the thumb, arthroplasty is gaining popularity as modern implants show excellent mid-term outcome. Although current forth generation implants for wrist replacement are promising, total wrist arthroplasty is currently reserved for exceptional indications.
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Affiliation(s)
- Ali Ayache
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.
| | - Christian K Spies
- Handchirurgie, Spital Langenthal, Spital Region Oberaargau SRO AG, Langenthal, Schweiz
| | - Frank Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
- Medizinische Fakultät Mannheim, Ruprecht-Karls Universität Heidelberg, Theodor-Kutzer-Ufer, Mannheim, Deutschland
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Cummings PE, Claxton MR, Wagner ER, Rizzo M. Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected by Rheumatoid Arthritis. Hand (N Y) 2023; 18:931-937. [PMID: 35043719 PMCID: PMC10470233 DOI: 10.1177/15589447211063577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) affecting the metacarpophalangeal (MCP) joint may warrant arthroplasty. The purpose of this study was to investigate implant survivorship, complications, radiographic outcomes, and clinical outcomes in patients undergoing MCP arthroplasty with a pyrocarbon implant to treat RA. METHODS In all, 124 MCP joint pyrocarbon arthroplasties in 40 patients performed to treat RA were reviewed. Operations were at the index (n = 43, 35%), middle (n = 33, 27%), ring (n = 27, 22%), and small (n = 21, 17%) fingers from 1998 to 2009 in 105 (85%) female and 19 (15%) male joints with a mean age of 54 ± 11 years. Mean postoperative follow-up was 6 ± 3 years. All patients achieved at least 2 years of follow-up. RESULTS Rates of implant survivorship at 1, 2, 5, and 10 years were 98%, 98%, 90%, and 81%, respectively. Fifteen percent (n = 18) of arthroplasties underwent revision at a mean 5 ± 3 years postoperatively. The overall reoperation rate was 29% (n = 36). Rates of survival from reoperation at 1, 2, 5, and 10 years were 85%, 84%, 76%, and 68%, respectively. Complications occurred in 32% (n = 40). Pain ratings improved postoperatively (P < .01). Arc of motion improved from 37 ± 21 to 43 ± 19 (P = .03). Both appositional and oppositional strength improved after surgery; however, there was no improvement in grip strength (P < .01). CONCLUSIONS Metacarpophalangeal arthroplasty with a pyrocarbon implant demonstrated reliable improvement in pain and arc of motion in patients with RA. Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively.
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Ito H, Nishida K, Kojima T, Matsushita I, Kojima M, Hirata S, Kaneko Y, Kishimoto M, Kohno M, Mori M, Morinobu A, Murashima A, Seto Y, Sugihara T, Tanaka E, Nakayama T, Yamanaka H, Kawahito Y, Harigai M. Non-drug and surgical treatment algorithm and recommendations for the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication. Mod Rheumatol 2023; 33:36-45. [PMID: 35294030 DOI: 10.1093/mr/roac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) and prepare an algorithm for non-drug and surgical treatments. This article is a digest version of the guidelines. METHODS The Japanese Ministry of Health, Labour and Welfare's research group, in collaboration with the JCR, used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. The consensus was formed by CPG panel members. RESULTS We raised 19 clinical questions regarding non-drug and surgical treatments for RA and developed recommendations. The treatments included exercise therapy; occupational therapy; joint injection of corticosteroids; and orthopaedic surgeries including cervical spine surgery, wrist and foot arthroplasty, ankle arthrodesis, and replacement arthroplasty of the shoulder, elbow, finger, hip, knee, and ankle. Recommendations regarding the risks of surgery and perioperative discontinuation of medications have also been developed. Based on these recommendations, we created an original algorithm for the non-drug and surgical treatment of RA. CONCLUSIONS These recommendations are expected to serve rheumatologists, health care professionals, and patients with RA as tools for shared decision-making to treat residual limb joint symptoms and functional impairment.
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Affiliation(s)
- Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Keiichiro Nishida
- Department of Orthopedic Surgery, Okayama University Academic Field of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal, and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University School of Medicine, Yachiyo, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiichi Tanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Packham T, MacDermid JC, Selles RW, Slijper HP, Wouters R. Rasch Analysis of the Michigan Hand Questionnaire. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:638-646. [PMID: 35365308 DOI: 10.1016/j.jval.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics. METHODS We conducted a secondary Rasch analysis of MHQ data from 924 persons with thumb basal joint osteoarthritis using the RUMM2030 software. Modeling was based on responses for the most affected hand and person factors including age, sex, type of work, whether the dominant side was the most affected, and surgical status. The analysis plan followed the published recommendations for examinations of person and item fit, with iterative adjustments as required. RESULTS A total of 11 of the 37 items required rescoring to create orderly progression of scoring thresholds. Only the overall hand function and pain subscales could be fit to the Rasch model, demonstrating unidimensionality and good reliability of fit estimates. Dividing the activities of daily living subscale into unilateral and bilateral activities also allowed unilateral activities to fit the model. Persistent misfitting in other subscales suggested local dependency and response bias across multiple person factors. CONCLUSIONS This Rasch analysis of the MHQ raises concerns regarding the validity and fundamental measurement properties of this widely used outcome evaluation when used as a summary score.
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Affiliation(s)
- Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; School of Physiotherapy, Western University, London, Ontario, Canada
| | - Ruud W Selles
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Harm P Slijper
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
| | - Robbert Wouters
- Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
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Herren DB, Ishikawa H, Rizzo M, Ross M, Solomons M. Arthroplasty in the hand: what works and what doesn't? J Hand Surg Eur Vol 2022; 47:4-11. [PMID: 34018871 DOI: 10.1177/17531934211017703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia
| | - Michael Solomons
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Abi-Rafeh J, ElHawary H, Azzi AJ, Thibaudeau S. Pyrocarbon Arthroplasty Implants in the Upper Extremity: A Systematic Review of Outcomes and Pooled Analysis of Complications. Plast Reconstr Surg 2021; 148:946e-958e. [PMID: 34847116 DOI: 10.1097/prs.0000000000008514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Growing use of pyrocarbon implants in upper extremity arthroplasty has culminated in a breadth of literature ascertaining outcomes and complications at long-term follow-up. However, at present, the literature remains devoid of studies synthesizing the available evidence for upper extremity surgeons to adequately assess the safety and utility of these implants relative to other available options. METHODS A systematic search of the National Library of Medicine, MEDLINE, and Embase databases was performed to determine clinical outcomes and complication and reoperation rates following pyrocarbon arthroplasties in the upper extremity. A breakdown of complication and reoperation rates for each independent joint (shoulder, elbow, wrist, and hand joints), and according to specific causes necessitating surgery, was also compiled. RESULTS A comprehensive summary of functional outcomes following upper extremity pyrocarbon arthroplasties is presented. Overall complication and reoperation rates in the hand and wrist were determined to be 28.2 percent and 17 percent, respectively. The proximal interphalangeal joint was associated with the highest complication rate (42.7 percent), followed by carpometacarpal joint (18.8 percent), metacarpophalangeal joint (17.6 percent), wrist (16 percent), elbow (15.7 percent), and shoulder (12.9 percent). In the hand and wrist, major complications included dislocations and subluxations (8.4 percent), stiffness and limited motion (4.4 percent), deformity (3.1 percent), hardware failure (1.9 percent), fractures (1.7 percent), persistent pain (1.7 percent), and infections (0.9 percent). CONCLUSION In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence-based reference to improve informed consent.
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Affiliation(s)
- Jad Abi-Rafeh
- From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Hassan ElHawary
- From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Alain J Azzi
- From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Stephanie Thibaudeau
- From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
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Park JW, Hwang JS, Gong HS. Rheumatoid Hand Surgery in the Era of Biologic Therapy: A Rheumatologist-oriented Overview. JOURNAL OF RHEUMATIC DISEASES 2021; 28:192-201. [PMID: 37476361 PMCID: PMC10324912 DOI: 10.4078/jrd.2021.28.4.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 07/22/2023]
Abstract
Rheumatoid arthritis (RA) can cause significant hand and wrist damage and dysfunction. The aim of medical treatment is to eradicate inflammation and prevent damage to joints and soft tissues. Advances in newer biological therapies over the last two decades have resulted in greater remission rates and lower disease activity status. Despite these improvements, surgical intervention is still indicated in cases of disability, irreversible deformities, and severe pain. However, there are large variations in the surgical rates of common rheumatoid hand procedures, which may indicate clinical uncertainty or disagreement between treating rheumatologists and hand surgeons. In this review, we provide a basic overview of common problems of the hand and wrist in RA patients. The target audience is rheumatologists for their better understanding of surgical options and for better informed patient consultation before referring to hand surgeons.
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Affiliation(s)
- Jin Woo Park
- Department of Orthopedic Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Ji Sup Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Jayaram M, Wang C, Wang L, Chung KC. Validating the Michigan Hand Outcomes Questionnaire in patients with rheumatoid arthritis using Rasch analysis. PLoS One 2021; 16:e0254984. [PMID: 34293037 PMCID: PMC8297815 DOI: 10.1371/journal.pone.0254984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Michigan Hand Outcomes Questionnaire (MHQ) is a patient-reported outcome measure previously validated in patients with rheumatoid arthritis (RA) using classical test theory. Rasch analysis is a more rigorous method of questionnaire validation that has not been used to test the psychometric properties of the MHQ in patients with RA. The objective of this study is to evaluate the validity and reliability of the MHQ for measuring outcomes in patients with RA with metacarpophalangeal joint deformities. METHODS We performed a Rasch analysis using baseline data from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) prospective cohort study. All domains were tested for threshold ordering, item fit, targeting, differential-item functioning, unidimensionality, and internal consistency. RESULTS The Function and Work domains showed excellent fit to the Rasch model. After making adjustments, the Pain, Activities of Daily Living (ADL) and Satisfaction domains also fulfilled all Rasch model criteria. The Aesthetics domain met the majority of Rasch criteria, but could not be tested for unidimensionality. CONCLUSIONS After collapsing disordered thresholds and removing misfitting items, the MHQ demonstrated reliability and validity for assessing outcomes in patients with RA with metacarpophalangeal joint deformities. These results suggest that interpreting individual domain scores may provide more insight into a patient's condition rather than analyzing an overall MHQ summary score. However, more Rasch analyses are needed in other RA populations before making adjustments to the MHQ.
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Affiliation(s)
- Mayank Jayaram
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Chang Wang
- University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Lu Wang
- University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Kevin C. Chung
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Michigan, United States of America
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Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3520. [PMID: 33889471 PMCID: PMC8057752 DOI: 10.1097/gox.0000000000003520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Background Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function. Methods Thirty-one patients with osteoarthritis of the CMC, MCP, or PIP joints underwent arthroplasty with meniscal allograft. Patient demographics and operative information were recorded. Preoperative Disability of the Shoulder, Arm, and Hand, Wong Baker pain, grip and pinch strength, and range of motion were compared to postoperative scores at 6 weeks, 6 months, and 1 year. Results Twenty-three women and 8 men, mean age 62.8 years, underwent 39 joint reconstructions, including CMC (n = 26), thumb MP (n = 2), thumb IP (n = 2), digit MP (n = 2), and digit PIP (n = 7). At 1 year, mean Disability of the Shoulder, Arm, and Hand scores decreased from 41.3 to 15.6 (P < 0.001) and pain scores from 6.9 to 1.0 (P < 0.001). Grip strength increased from 38.1 to 42.9 (P = 0.017) and radial and palmar abduction from 43.1 to 49.2 (P = 0.039) and 43.7 to 51.6 (P = 0.098), respectively. There were no complications related to the meniscus. Conclusions Meniscal allograft represents an alternative to arthrodesis which obviates the need for a donor site and avoids many of the complications inherent to synthetic alternatives. Our early results demonstrate its successful use to reduce subjective pain and disability scores, improve objective strength measures, and maintain range of motion.
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Risk Factors Contributing to Early Implant Fracture in Silicone Metacarpophalangeal Joint Arthroplasty for Patients With Rheumatoid Arthritis. J Hand Surg Am 2021; 46:243.e1-243.e7. [PMID: 33162271 DOI: 10.1016/j.jhsa.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the risk factors associated with early implant fracture of silicone metacarpophalangeal (MCP) joint arthroplasty using the volar hinge silicone implant for patients with rheumatoid arthritis. METHODS We retrospectively reviewed 113 fingers of 31 hands that underwent MCP joint arthroplasty between 2008 and 2014, with a minimum follow-up of 3 years,. An implant fracture within 3 years after surgery was regarded as an early implant fracture. Patient records were reviewed for potential risk factors of age, affected fingers, ulnar drift angle, and range of motion of the MCP joint before surgery and 1 year after surgery. Candidate risk factors were compared at the level of the digit and at the patient level. RESULTS With fracture of the implants as the end point, Kaplan-Meier estimated survival rate was 74.3% at 3 years and 67.9% at 5 years. Early implant fracture was detected in 29 fingers. Bivariate analyses showed significant associations between early implant fracture and MCP joint arc of motion before surgery, MCP joint flexion range 1 year after surgery, and MCP joint arc of motion 1 year after surgery. Multiple logistic regression analysis showed that increased MCP joint flexion range 1 year after surgery was an independent risk factor for early implant fracture. CONCLUSIONS Increasing MCP joint flexion range was associated with increased fractures of the implants. We propose that the MCP joint flexion range should be restricted to less than 60° in postoperative rehabilitation; it is necessary to educate the patient to permanently avoid excessive flexion of the MCP joint. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Estermann L, Marks M, Herren D, Schindele S. Determinants of long-term satisfaction after silicone MCP arthroplasty in patients with inflammatory diseases. HAND SURGERY & REHABILITATION 2020; 39:545-549. [DOI: 10.1016/j.hansur.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
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Notermans BJW, Lans J, Arnold D, Jupiter JB, Chen NC. Factors Associated With Reoperation After Silicone Metacarpophalangeal Joint Arthroplasty in Patients With Inflammatory Arthritis. Hand (N Y) 2020; 15:805-811. [PMID: 32122171 PMCID: PMC7850254 DOI: 10.1177/1558944719831236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Silicone metacarpophalangeal (MCP) joint arthroplasty has a high revision rate. It has been suggested that the preoperative degree of ulnar drift and radial wrist deviation influences the durability of MCP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone MCP arthroplasty. Materials and Methods: We retrospectively evaluated all adult patients who underwent MCP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory arthritis. After manual chart review, we included 73 patients who underwent 252 arthroplasties. Fingers treated included 66 index, 67 long, 60 ring, and 59 small fingers. Results: The overall reoperation rate was 9.1% (N = 23). Indications for reoperation were implant breakage (n = 11), instability (n = 4), soft tissue complications (n = 4), infections (n = 3), and stiffness (n = 1). There was a trend that patients who underwent single-digit arthroplasty had higher rates of revision (19% vs 3.5%, P = .067). Radiographic follow-up demonstrated joint incongruency in 50% of cases, bone erosion in 58% of cases, and implant breakage in 19% of cases. There was a trend toward higher rates of revision in patients without preoperative MCP joint subluxation (19% vs 6.7%, P = .065) The 1-, 5-, and 10-year implant survival rates were 96%, 92%, and 70%, respectively. Revision surgery occurred at <14 months in 15 patients (65%) and after 5 years in 8 (35%) patients. Conclusions: Revision surgery after silicone MCP arthroplasty appears to be bimodal. Patients with greater hand function preoperatively may be at higher risk of revision surgery.
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Affiliation(s)
- Bo J. W. Notermans
- Massachusetts General Hospital, Boston, USA,Bo J. W. Notermans, Kaatstraat 47, Utrecht, 3513 BV, The Netherlands.
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Mitigating Biases in a Cohort Study: A Critical Examination of the Silicone Arthroplasty in Rheumatoid Arthritis Study. Plast Reconstr Surg 2020; 145:746-754. [PMID: 32097319 DOI: 10.1097/prs.0000000000006602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.
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Abstract
Rheumatoid arthritis is one common form of inflammatory arthritis that affects about 1% of the population. Few conditions in hand surgery have undergone such fundamental changes within the last two decades as rheumatoid arthritis has with regard to clinical presentations and treatments. This article provides a personal practice-guided review of the author's decision making and treatment for patients with rheumatoid arthritis in the past two decades.
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