1
|
Lirola-Palmero S, Salva-Coll G, Yáñez-Juan AM, Sánchez-Iriso E. Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial. Trials 2024; 25:220. [PMID: 38532422 PMCID: PMC10967180 DOI: 10.1186/s13063-024-08057-1] [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] [Received: 08/25/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction. METHODS A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial's eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial's primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider's and society perspective using direct and indirect medical costs. DISCUSSION This is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA. TRIAL REGISTRATION ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.
Collapse
Affiliation(s)
- Serafín Lirola-Palmero
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain.
| | - Guillem Salva-Coll
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain
| | | | | |
Collapse
|
2
|
Uhlman K, Gormley J, Churchill I, Huynh M, Leveille CF, McRae MH, McRae MC, Musgrave MA. Outcomes in Facial Feminization Surgery: A Systematic Review. Facial Plast Surg Aesthet Med 2024; 26:236-244. [PMID: 35486849 DOI: 10.1089/fpsam.2021.0293] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Review literature on facial feminization surgery (FFS) for the transgender population and identify whether heterogeneity in reported outcomes and outcome measures exists across studies, as measured by a lack of consensus, and number of outcomes and outcome measures used. Evidence Review: A search of MEDLINE and EMBASE (database inception to January 20, 2021) was performed to retrieve FFS studies. Primary outcomes included number of reported outcomes and outcome measures; secondary outcomes included clinimetric properties of outcome measures and study characteristics. Findings: In total, 15 articles were included. Sixty-nine outcomes and 12 outcome measures were identified. Of those outcome measures, zero were found to be valid, reliable, and responsive in patients who had undergone FFS. A variety of FFS interventions were studied, with the three most common interventions being: rhinoplasty (n = 7, 46.7%), mandibuloplasty (n = 7, 46.7%), and chondrolaryngoplasty (n = 6, 40%). Conclusion and Relevance: Heterogeneity was evident in reported outcomes and outcome measures in FFS literature and there is currently no outcome measure commonly used for this patient population.
Collapse
Affiliation(s)
- Kathryn Uhlman
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Gormley
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Isabella Churchill
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Minh Huynh
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Cameron F Leveille
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mark H McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Melinda A Musgrave
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [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] [Indexed: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
Collapse
Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
| |
Collapse
|
4
|
Saggaf MM, Roy M, Antflek D, Borkhoff CM, Baltzer H. Assessing Responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire. Hand (N Y) 2024; 19:96-103. [PMID: 36050926 PMCID: PMC10786116 DOI: 10.1177/15589447221120840] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA). METHODS This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients. RESULTS The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively (P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections (P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires (r = 0.87, P < .0001). CONCLUSIONS The TASD is a promising TMC-OA-specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.
Collapse
Affiliation(s)
- Moaath M. Saggaf
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Mélissa Roy
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- The Hospital for Sick Children and University of Toronto, ON, Canada
| | | | - Cory M. Borkhoff
- University of Toronto, ON, Canada
- The Hospital for Sick Children and University of Toronto, ON, Canada
| | - Heather Baltzer
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Toronto Western Hospital, ON, Canada
| |
Collapse
|
5
|
Mert S, Emelianova I, Möllhoff N, Bader MC, Giunta R, Maria Haas-Lützenberger E. [German Translation and Validation of the Patient-Oriented Questionnaire "Thumb Disability Examination" (TDX) for Specific Diagnosis and Follow-Up of Thumb Carpometacarpal Joint Osteoarthritis]. HANDCHIR MIKROCHIR P 2023; 55:443-449. [PMID: 38061361 DOI: 10.1055/a-2192-9410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are becoming increasingly important in today's patient care. Unfortunately, the most common PROMs in hand surgery are very time-consuming and usually do not cover the actual, diagnosis-specific complaints of the patients. For diagnosis and follow-up of thumb carpometacarpal joint osteoarthritis, Noback et al. developed and validated the Thumb Disability Examination (TDX) questionnaire. This 20-item questionnaire specifically assesses daily living limitations and pain as well as patient-reported satisfaction of thumb function. The aim of this study is to validate the German translation of the TDX, the Thumb Disability Examination - German (TDX-G), and to compare it with the German-language versions of the MHQ and qDASH, which are currently used as gold standard. MATERIAL UND METHODS Translation and back-translation were performed in accordance with accepted guidelines. For statistical validation of the TDX-G, 30 consecutive patients with thumb carpometacarpal joint osteoarthritis were interviewed under standardised conditions. Internal consistency was calculated using Cronbach's alpha. Test-retest reliability was determined in 10 patients who completed the TDX-G twice at an interval of 2 weeks. The validity of the TDX-G was determined by calculating the correlation coefficients of the TDX-G with the MHQ and qDASH, subjective pain sensation (NRS), and hand strength levels (coarse and pinch strength). In addition, the time to collect each questionnaire was compared. RESULTS The TDX-G has high internal consistency (Cronbach's alpha 0.932) and test-retest reliability (intraclass correlation coefficient 0.963 [0.850-0.991]). There is a significant correlation between TDX-G and MHQ (- 0.782; p<0.001) and qDASH (0.833; p<0.001). All questionnaires correlate significantly with pain on exertion and pinch force, with the TDX-G having the highest correlation in each case. Significantly less time is needed to record the TDX-G (110±28 s) than to record the MHQ (413±98 s). CONCLUSION The TDX-G is a reliable tool for diagnosing and monitoring the progression of thumb carpometacarpal joint osteoarthritis. It can be used in both patient care and clinical research and accurately mirrors the symptoms.
Collapse
Affiliation(s)
- Sinan Mert
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU Klinikum, München, Germany
| | - Iana Emelianova
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU Klinikum, München, Germany
| | - Nicholas Möllhoff
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU Klinikum, München, Germany
| | - Moritz Christian Bader
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU Klinikum, München, Germany
| | - Riccardo Giunta
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU Klinikum, München, Germany
| | | |
Collapse
|
6
|
Uhlman K, Abdel Khalik H, Murphy J, Karpinski M, Thoma A. Reported Outcomes and Outcome Measures in Proximal Interphalangeal Joint Arthroplasty: A Systematic Review. Plast Surg (Oakv) 2023; 31:236-246. [PMID: 37654529 PMCID: PMC10467432 DOI: 10.1177/22925503211042864] [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: 05/04/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 09/02/2023] Open
Abstract
Purpose: There is a lack of scientific consensus on the best arthroplasty implant option for proximal interphalangeal joint (PIPJ) arthritis, due to diversity in outcome reporting and measurement methods. The development of a standardized core outcome set (COS) and standard outcome measures could mitigate this issue. This study catalogs the reported outcomes and outcome measures found in PIPJ arthroplasty studies, which can be used in the first step of developing a COS. Methods: A database search of MEDLINE, EMBASE, and Web of Science (January 1, 2010, to March 10, 2021) was performed to retrieve studies that reported outcomes of the 3 most common primary PIPJ arthroplasty implants: silicone, pyrocarbon, and metal-polyethylene. The primary objectives of this study include reported outcomes and outcome measures. Secondary objectives include clinimetric properties of outcome measures, study design, and implant types. Results: Fifty articles met inclusion criteria. Of the included studies, 41 (82%) were case series, 8 (16%) were cohort studies, and 1 (2%) was a randomized control trial. Thirty-three unique outcomes were identified. Fifteen (46%) outcomes were clinician-reported and 26 (79%) were patient-reported. Eighteen unique outcome measures were identified. Of the outcome measures, 15 (83%) were patient-reported, 1 (6%) was clinician-reported, and 2 (11%) were reported by both patients and clinicians. Conclusions: Substantial heterogeneity was found in reported outcomes and outcome measures across studies evaluating PIPJ arthroplasty, impeding knowledge translation. The development of a COS for PIPJ arthroplasty is necessary to help compare and pool data across studies, and advance scientific knowledge.
Collapse
|
7
|
Vargas-Reverón C, Ríos-Guillermo J, Chimeno-Pigrau C, Carreño-Delgado A, Narváez-Saldivia JD, Arandes-Renú JM. Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T117-T124. [PMID: 36535343 DOI: 10.1016/j.recot.2022.12.013] [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: 06/12/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.
Collapse
Affiliation(s)
- C Vargas-Reverón
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Universidad de Barcelona e Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J Ríos-Guillermo
- Plataforma de Estadística Médica, Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - C Chimeno-Pigrau
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Universidad de Barcelona e Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - A Carreño-Delgado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Universidad de Barcelona e Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J D Narváez-Saldivia
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Universidad de Barcelona e Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J M Arandes-Renú
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Universidad de Barcelona e Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| |
Collapse
|
8
|
Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:117-124. [PMID: 36243393 DOI: 10.1016/j.recot.2022.10.001] [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: 06/12/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.
Collapse
|
9
|
Marks M. Outcome measurement in trapeziometacarpal osteoarthritis: commentary and personal opinions. J Hand Surg Eur Vol 2022; 47:973-975. [PMID: 35983684 DOI: 10.1177/17531934221117226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland Twitter: @SchulthessNews
| |
Collapse
|
10
|
Hu T, Long Y, Chen R, Yang Z, Liu L, Huang L, Huang J, Liao G, Du L. Core outcomes were rarely reported overall in systematic reviews on acupuncture for osteoarthritis: a cross-sectional meta-epidemiological study. Acupunct Med 2022:9645284221108215. [PMID: 35983785 DOI: 10.1177/09645284221108215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify a comprehensive list of outcomes and explore the reporting rate of core outcome sets (COS) and related factors in systematic reviews (SRs) of acupuncture for osteoarthritis (OA). STUDY DESIGN AND SETTING Databases were searched for the relative SRs. Descriptive statistics were calculated as frequencies and percentages. Binary logistic regression was used to explore the factors affecting the reporting rate of COS. RESULTS We included 59 SRs. Outcome measures reported in the SRs were classified into 11 domains and 67 unique outcomes. No SR completely reported COS. In COS released in 2016, 75% of outcomes (6/8) were only reported by ⩽5% SRs. In COS released in 2019, the reporting rate was very low (from 0% to 17%) for 73.3% of outcomes (11/15). SRs published in the most recent 5 years had a significantly greater possibility of reporting COS (odds ratio (OR) = 4.74, 95% confidence interval (CI) = 1.33 to 16.88, p = 0.016). CONCLUSION Core outcomes were rarely reported in systematic reviews of acupuncture for OA, with considerable heterogeneity in the use of outcomes. The publication of COS in the COMET (Core Outcome Measures in Effectiveness Trials) database may help promote the reporting of COS. We encourage systematic reviewers to use relevant COS.
Collapse
Affiliation(s)
- Tengyue Hu
- West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Youlin Long
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, P.R. China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Rui Chen
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
| | - Zixin Yang
- West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Liqin Liu
- West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Litao Huang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jin Huang
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Ga Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, P.R. China.,Medical Big Data Center, Sichuan University, Chengdu, P.R. China.,Departments of Information Management and Stomatology Informatics, West China Hospital of Stomatology, Sichuan University, Chengdu, P.R. China
| | - Liang Du
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, P.R. China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| |
Collapse
|
11
|
Abstract
SUMMARY In 1906, George Bernard Shaw criticized the medical profession for its lack of science and compassion. Since then, advances in both medical and surgical subspecialties have improved quality of patient care. Unfortunately, the reporting of these advances is variable and is frequently biased. Such limitations lead to false claims, wasted research dollars, and inability to synthesize and apply evidence to practice. It was hoped that the introduction of evidence-based medicine would improve the quality of health care and decrease health dollar waste. For this to occur, however, credible "best evidence"-one of the components of evidence-based medicine-is required. This article provides a framework for credible research evidence in plastic surgery, as follows: (1) stating the clinical research question, (2) selecting the proper study design, (3) measuring critical (important) outcomes, (4) using the correct scale(s) to measure the outcomes, (5) including economic evaluations with clinical (effectiveness) studies, and (6) reporting a study's results using the Enhancing the Quality and Transparency of Health Research, or EQUATOR, guidelines. Surgeon investigators are encouraged to continue improving the science in plastic surgery by applying the framework outlined in this article. Improving surgical clinical research should decrease resource waste and provide patients with improved evidence-based care.
Collapse
|
12
|
Prognostic factors and clinical features in metacarpophalangeal joint hyperextension after ligament reconstruction with trapeziectomy: A retrospective cohort study. J Orthop Sci 2022:S0949-2658(22)00077-X. [PMID: 35430128 DOI: 10.1016/j.jos.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Management of metacarpophalangeal (MCP) hyperextension deformity in thumb carpometacarpal (CMC) joint arthritis is challenging. It remains unclear how the preoperative MCP joint angle affects the outcomes. The present study aimed to clarify the associations between postoperative MCP hyperextension deformity and outcomes, and to determine the preoperative MCP joint angle that can predict poor outcomes. METHODS We investigated the functional outcomes of patients who underwent surgery for CMC arthritis at two institutions from 2016 to 2020. All patients received a modified Thompson technique, ligament reconstruction suspension arthroplasty, and had no additional treatment for MCP hyperextension. The patients were divided into three groups according to their postoperative MCP joint angles: Group A, <10°; Group B, 10°-20°; Group C, >20°. Evaluations included preoperative and postoperative VAS, Quick DASH, range of motion (ROM), grip power, pinch strength, first web space angle, and postoperative trapezial space ratio (TSR). RESULTS Overall, 66 eligible patients (72 thumbs) were identified and received follow-up for a mean of 25.2 months. The 72 thumbs were assigned to Group A (n = 38), Group B (n = 16), and Group C (n = 18). Group C had significantly lower preoperative MCP joint angle and postoperative grip power, pinch strength, and TSR compared with the Group A (P < 0.05). However, there were no significant differences in VAS, Quick DASH, ROM, and first web space angle (P > 0.05). The preoperative risk factor for highly residual MCP hyperextension was preoperative MCP joint angle (OR = 1.078; P = 0.001), with a cut-off value of 21.5° (AUC = 0.79; sensitivity = 0.813; specificity = 0.821). CONCLUSIONS Postoperative MCP hyperextension of >20° after ligament reconstruction with trapeziectomy has adverse effects on functional outcomes. In cases with preoperative MCP joint angle of >21.5°, additional treatment for MCP hyperextension should be considered.
Collapse
|
13
|
Autologous Craniofacial Fat Grafting in the Irradiated Field. J Craniofac Surg 2021; 32:1742-1745. [PMID: 34319678 DOI: 10.1097/scs.0000000000007549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Autologous fat grafting has been used as a reconstructive modality following the treatment of head and neck malignancy. However, it has been criticized for poor graft retention and unpredictable results, which may be further compromised by prior radiation therapy. This systematic review will consolidate the literature on autologous fat grafting in the previously irradiated craniofacial region and report its effects on aesthetic and functional outcomes, volume resorption, and postoperative complications. A computerized search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. Sixty patients from six studies were included. Mean age was 46.06 years (range 13-73) and 37.5% were female. All studies used the Coleman technique fat grafting or a modified version. A total of 94.9% of patients had significant improvement in aesthetic outcomes and 86.1% in the study specific functional outcomes. Mean graft volume resorption was 41% (range 20%-62%) and there were three (5%) postoperative complications. Autologous fat grafting is increasingly being used to optimize aesthetic outcome following head and neck reconstruction, even in the presence of prior radiation treatment. Although the literature to date is encouraging, the heterogeneity in patient population, intervention, outcome measures, and time horizon limit our ability to draw conclusions about the success of craniofacial fat grafting in the irradiated field. Future research should include a large comparative study as well as a protocol for standardizing outcome measures in this population.
Collapse
|
14
|
Raj S, Clay R, Ramji S, Shaunak R, Dadrewalla A, Sinha V, Shaunak S. Trapeziectomy versus joint replacement for first carpometacarpal (CMC 1) joint osteoarthritis: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1001-1021. [PMID: 34244850 PMCID: PMC9279208 DOI: 10.1007/s00590-021-03070-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
Purpose This systematic review and meta-analysis directly compares joint replacement (JR) and trapeziectomy techniques to provide an update as to which surgical intervention is superior for first carpometacarpal (CMC-1) joint osteoarthritis. Methods In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (QDASH) and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation and revision surgery rates, were also measured. Results From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QDASH scores were lower for patients in the JR group (five studies, p = 0.0004). Similarly, significantly better postoperative key pinch strength in favour of JR was noted (three studies, p = 0.001). However, pain (VAS) scores were similar between the two groups (five studies, p = 0.21). Moreover, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.12; 95% CI 1.13–3.96, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06–12.81, p = 0.0004). Conclusion Overall, based on very low- to moderate-quality evidence, JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.
Collapse
Affiliation(s)
- Siddarth Raj
- King's College London, GKT School of Medicine, London, UK.
| | - Reece Clay
- King's College London, GKT School of Medicine, London, UK
| | - Saajan Ramji
- King's College London, GKT School of Medicine, London, UK
| | - Raghav Shaunak
- King's College London, GKT School of Medicine, London, UK
| | | | - Vikram Sinha
- King's College London, GKT School of Medicine, London, UK
| | - Shalin Shaunak
- Department of Trauma and Orthopaedic Surgery, NHS KSS Deanery, London, UK
| |
Collapse
|
15
|
Holme TJ, Karbowiak M, Clements J, Sharma R, Craik J, Ellahee N. Thumb CMCJ prosthetic total joint replacement: a systematic review. EFORT Open Rev 2021; 6:316-330. [PMID: 34150326 PMCID: PMC8183150 DOI: 10.1302/2058-5241.6.200152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Thumb carpometacarpal joint (CMCJ) arthritis is a common and painful condition. Thumb CMCJ prosthetic replacement aims to restore thumb biomechanics and improve pain and function. Early reviews demonstrated a lack of high-quality studies, but more recently a significant number of higher-quality studies have been published. This review provides a concise and systematic overview of the evidence to date. A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the outcomes of thumb CMCJ prosthetic total joint replacement were included. Data extracted included patient-reported outcome measures (PROMs), pain scores, range of motion, strength, survival rates and complications. A total of 56 studies met all inclusion criteria and were analysed. There was one randomized controlled trial, three prospective comparative cohort studies, five retrospective comparative cohort studies, and 47 descriptive cohort studies. The reported studies included 2731 patients with 3048 thumb total CMCJ prosthetic joint replacements. Follow up ranged from 12 months to 13.1 years. In general, good results were demonstrated, with improvements in PROMs, pain scores and strength. Failure rates ranged from 2.6% to 19.9% depending upon implant studied. Comparative studies demonstrated promising results for replacement when compared to resection arthroplasty, with modest improvements in PROMs but at a cost of increased rates of complications. Studies reporting outcomes in thumb CMCJ prosthetic total joint replacement are increasing in both number and quality. Failure, in terms of loosening and dislocation, remains a concern, although in the medium-term follow up for modern implants this issue appears to be lower when compared to their predecessors. Functional outcomes also look promising compared to resection arthroplasty, but further high-quality studies utilizing a standardized resection arthroplasty technique and modern implants, together with standardized core outcome sets, will be of value.
Cite this article: EFORT Open Rev 2021;6:316-330. DOI: 10.1302/2058-5241.6.200152
Collapse
Affiliation(s)
- Thomas J Holme
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Marta Karbowiak
- Royal Surrey NHS Foundation Trust, Trauma & Orthopaedics, Guildford, UK
| | - Jennifer Clements
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Ritesh Sharma
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Johnathan Craik
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Najab Ellahee
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| |
Collapse
|
16
|
Gormley J, Copeland A, Augustine H, Axelrod C, McRae M. Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review. Cureus 2020; 12:e12358. [PMID: 33520552 PMCID: PMC7839807 DOI: 10.7759/cureus.12358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rectus diastasis plication performed during abdominoplasty aims to narrow the widened linea alba and return the rectus muscle bellies to their anatomic position. It is unclear whether plication improves abdominal strength and function. This systematic review summarizes the effect of rectus plication on abdominal strength, function, and postoperative complications. A comprehensive search of CINAHL, Embase, Medline and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. A total of 497 patients from seven articles were included. Mean age was 44.5 years (range 20.5-72) and 94.4% were female. Three articles reported abdominal strength measurements, with two showing significant improvement. Four articles used the SF-36 survey, all demonstrating improvement in physical function subscale postoperatively. An additional six instruments were used to assess functional outcomes, of which four demonstrated significant improvement. The overall complication rate was 17.0%. Rectus plication is commonly performed during abdominoplasty to improve abdominal form and function. While the literature to date is encouraging with respect to functional outcomes, improvements in abdominal strength are less consistent. Heterogeneity in patient population, outcome measures, and comparison groups limit the strength of our conclusions. Future research should include a large comparative study as well as a protocol for standardizing outcomes in this population.
Collapse
Affiliation(s)
- Jessica Gormley
- Plastic Surgery, Michael G. DeGroote School of Medicine, Hamilton, CAN
| | | | | | - Charlotte Axelrod
- Plastic Surgery, University of Toronto Faculty of Medicine, Toronto, CAN
| | - Mark McRae
- Plastic Surgery, McMaster University, Hamilton, CAN
| |
Collapse
|