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Swärd EM, Beckman J, Tabaroj F, Wilcke MK. Efficacy of denervation for osteoarthritis in the proximal interphalangeal joint (DOP): protocol of a randomized controlled trial. Trials 2024; 25:553. [PMID: 39169395 PMCID: PMC11340183 DOI: 10.1186/s13063-024-08399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Osteoarthritis (OA) contributes increasingly to disability worldwide. There is ample high-quality research on the treatment of knee and hip OA, whereas research on surgical and non-surgical treatment in hand OA is sparse. Limited evidence suggests that education and exercise may improve pain, function, stiffness, and grip strength in hand OA. The established surgical options in hand OA have disadvantages. Prostheses preserve motion but have a high complication rate, whereas fusions decrease function due to limited movement. There is an unmet need for high-quality research on treatment options for hand OA and a need for the development of effective and safe movement-sparing therapies. This study aims to compare the effects of a motion-preserving surgical treatment (denervation of the proximal interphalangeal (PIP) joint) with a patient education and exercise program on patient-reported outcomes and objective function in painful PIP OA. METHODS In this parallel-group, two-armed, randomized, controlled superiority trial (RCT), 90 participants are assigned to surgical PIP joint denervation or education and exercise. Pain on load 1 year after intervention is the primary outcome measure. Secondary outcome measures include pain at rest, Patient-Rated Wrist and Hand Evaluation (PRWHE), HQ8 score, EQ5D-5L, objective physical function, complications, two-point discrimination, Mini Sollerman, consumption of analgesics, and the need for further surgery. Assessments are performed at baseline, 3 and 6 months, and 1 year after intervention. DISCUSSION There are no previous RCTs comparing surgical and non-surgical treatment in PIP OA. If patient education plus exercise or PIP denervation improve function, these treatments could be implemented as first-line treatment options in PIP OA. However, if denervation does not achieve better results than non-surgical treatment, it is not justified to use in PIP OA. TRIAL REGISTRATION Prospectively registered in ClinicalTrials.gov (NCT05980793) on 8 August 2023. URL https://classic. CLINICALTRIALS gov/ct2/show/NCT05980793 .
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Affiliation(s)
- Elin M Swärd
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, 11883, Sweden.
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden.
- Handkirurgiska kliniken Södersjukhuset, Sjukhusbacken 10, Stockholm, 11883, Sweden.
| | - Jonas Beckman
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | | | - Maria K Wilcke
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, 11883, Sweden
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
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Lifchez SD, Shores JT, Tuffaha SH. Small Joint Denervation of the Hand and Thumb Base: History, Anatomy, Technique, and Outcomes. J Hand Surg Am 2024; 49:592-601. [PMID: 38323946 DOI: 10.1016/j.jhsa.2023.12.015] [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: 08/20/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Painful arthritis of the small joints of the hand is a common condition affecting older adults, with distal interphalangeal joint and thumb carpometacarpal joint being the two most common locations. Younger adults may also develop painful arthritis after trauma and with inflammatory arthropathy. Traditional surgical approaches address the structure of the joints with either arthrodesis or arthroplasty with or without an implant. In recent decades, denervation has been reported as an alternative treatment for painful small joints that are mobile and stable. Publications on denervation often report faster surgery and recovery times than traditional surgeries that manipulate the small joint bony structures. This article reviews the history, anatomy, surgical techniques, and outcomes of denervation of the small joints of the hand.
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Affiliation(s)
- Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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van der Meulen C, van de Stadt LA, Claassen A, Kroon FPB, Ritt MJPF, Rosendaal FR, Terpstra SES, Vochteloo AJH, Kloppenburg M. Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review. RMD Open 2023; 9:e003134. [PMID: 37532467 PMCID: PMC10401234 DOI: 10.1136/rmdopen-2023-003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a research agenda. METHODS A systematic literature search was performed up to September 2022. Two investigators independently identified studies that reported on denervation for OA of the proximal interphalangeal, distal interphalangeal, metacarpophalangeal or carpometacarpal joints. Quality of studies was assessed and study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted. RESULTS Of 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. Sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. One non-randomised clinical trial reported no difference in outcome when comparing denervation of the first carpometacarpal (CMC I) joint to trapeziectomy. Adverse events were frequent, with sensory abnormalities occurring the most, followed by the need for revision surgery. All studies had significant risk of bias. CONCLUSION Surgical denervation for pain in hand OA shows some promise, but the available evidence does not allow any conclusions of efficacy and higher-quality research is needed. Techniques should be harmonised and more data regarding how denervation compares to current usual care, other denervation methods or placebo in terms of outcomes and adverse events are needed.
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Affiliation(s)
| | - Lotte A van de Stadt
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Aniek Claassen
- Dutch Society for Rheumatology, Utrecht, The Netherlands
| | - Féline P B Kroon
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frits R Rosendaal
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anne J H Vochteloo
- Department of Orthopaedics, OCON Orthopedische kliniek, Hengelo, The Netherlands
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Chang CC, Lin SY, Lu CK, Jupiter JB, Fu YC, Liu WC. Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints. J Clin Med 2023; 12:4760. [PMID: 37510875 PMCID: PMC10381317 DOI: 10.3390/jcm12144760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0-10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3-56.8) were included in this study. The median follow-up period was 6.5 years (range of 5-11 years). The median numeric pain scale improved from 5 (IQR: 4.3-6.0) preoperatively to 0 (IQR 0-0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints.
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Affiliation(s)
- Chung-Chia Chang
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Sung-Yen Lin
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
| | - Chun-Kuan Lu
- Department of Orthopedic, Park One International Hospital, Kaohsiung 813017, Taiwan
| | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801735, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
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Denervation of the Joints of the Hand and Wrist: Surgical Techniques and a Systematic Review with Meta-Analysis. Plast Reconstr Surg 2021; 148:959e-972e. [PMID: 34847117 DOI: 10.1097/prs.0000000000008517] [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 Joint denervation of the wrist, basal joint of the thumb, and the finger is an option for patients with chronic pain. Compared with other surgical treatment options, function is preserved and the rehabilitation time is limited. A systematic review and meta-analysis were performed for each joint to determine whether the choice of technique and choice of denervation of specific articular sensory branches lead to a different outcome. METHODS Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar database searches yielded 17 studies with reported outcome on denervation of the wrist, eight on the basal joint of the thumb, and five on finger joints. RESULTS Overall, the level of evidence was low; only two studies included a control group, and none was randomized. Meta-analysis for pain showed a 3.3 decrease in visual analogue scale score for wrist pain. No difference was found between techniques (total versus partial denervation), nor did different approaches influence outcome. The first carpometacarpal joint showed a decrease for visual analogue scale score for pain of 5.4. Patient satisfaction with the treatment result was 83 percent and 82 percent, respectively. Reported pain in finger joints decreased 96 percent in the metacarpophalangeal joints, 81 percent in the proximal interphalangeal joint, and 100 percent in the distal interphalangeal joint. The only reported case in the metacarpophalangeal joint of the thumb reported an increase of 37 percent. CONCLUSIONS Only denervation of the metacarpophalangeal joint of the thumb reported an increase in pain; however, this was a single patient. Wrist and first carpometacarpal joint and finger joint denervation have a high satisfaction rate and decrease the pain. There was no difference between techniques.
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Servasier L, Laulan J, Marteau E, Bacle G. Denervation of the proximal interphalangeal joint: Results from 54 cases in 42 patients. Orthop Traumatol Surg Res 2021; 107:102976. [PMID: 34091083 DOI: 10.1016/j.otsr.2021.102976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arthropathy of the proximal interphalangeal joint (PIP) is common. Joint denervation is a symptomatic treatment. It relieves pain by cutting the afferent nerve branches without altering joint biomechanics, and is indicated in painful arthropathy with conserved range of motion. The objective of this study was to evaluate clinical outcome in PIP denervation and the sustainability of results. HYPOTHESIS Denervation is an effective intervention in painful PIP arthropathy with functional range of motion, showing lasting benefit. PATIENTS AND METHODS A single-center retrospective study included all patients with painful PIP arthropathy with functional range of motion treated by denervation between January 2005 and September 2018 and evaluated by an independent examiner. Joint stiffness was an exclusion criterion. 54 consecutive denervation procedures were performed in 42 patients (41 women, 1 man) with a mean age of 66.5 years (range, 44-78 years). There were 11 inflammatory and 43 degenerative arthropathies. RESULTS The 42 patients were evaluated in consultation or contacted by telephone, with a mean follow-up of 51 months (range, 4-168 months). Mean VAS pain score was 7.5/10 (range, 5-10) before the procedure and 1.1/10 (range, 0-8) at last follow-up. Patients considered their joint cured or improved in 78% of cases whatever the etiology (42 cases/54), and in 86% of cases of degenerative arthropathy (37 cases/43). 32 patients were satisfied or very satisfied with the intervention (76% of cases). Active range of motion was improved in 16 cases, unchanged in 33 and impaired in 5. There were 7 denervation failures, which led to surgical treatment by fusion (2 cases) or joint replacement (5 cases); 5 of these cases concerned arthropathy of inflammatory origin. CONCLUSION Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Lisa Servasier
- Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France.
| | - Jacky Laulan
- Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France
| | - Emilie Marteau
- Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France
| | - Guillaume Bacle
- Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France
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