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De Vitis R, Taccardo G, Passiatore M, Boekstyns M, Marks M, Herren DB. Re: Herren DB, Boeckstyns M, Chung KC et al. Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study. J Hand Surg Eur Vol. 2024. doi: 10.1177/17531934241227386. J Hand Surg Eur Vol 2024:17531934241248567. [PMID: 38684448 DOI: 10.1177/17531934241248567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS - Roma - UOC di Ortopedia e Chirurgia della Mano, Rome, Italy
| | - Giuseppe Taccardo
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS - Roma - UOC di Ortopedia e Chirurgia della Mano, Rome, Italy
| | - Marco Passiatore
- ASST Spedali Civili di Brescia. S.C. Ortopedia e Traumatologia - Clinica Ortopedica, Brescia, Italy
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Marks M, Oyewale M, Neumeister S, Schindele S, Herren DB. Preoperative Thresholds of Pain and Function to Achieve a Minimal Important Change and Patient Acceptable Symptom State After Proximal Interphalangeal Joint Arthroplasty. J Hand Surg Am 2024; 49:382.e1-382.e7. [PMID: 36202674 DOI: 10.1016/j.jhsa.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 06/17/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There is ongoing discussion about the level of symptoms patients with proximal interphalangeal (PIP) joint osteoarthritis should have to undergo surgery. The aims of our study were to determine the minimal important change (MIC) and patient acceptable symptom state (PASS) for PIP joint range of motion (ROM), and define clinically relevant thresholds of preoperative pain and function at which patients have the greatest chance to achieve a MIC and PASS in these outcomes 1 year after PIP arthroplasty. METHODS We analyzed registry data that included patients with PIP joint osteoarthritis who underwent an arthroplasty for this condition and had a 1-year follow-up. Patients indicated pain on a numeric rating scale (0-10) and completed the brief Michigan Hand Outcomes Questionnaire (MHQ). Active total PIP ROM was measured. The preoperative thresholds, predictive of achieving the MIC and PASS for each outcome measure of pain, function, and ROM, were determined using receiver operating characteristics curves. RESULTS We included 196 patients who experienced a relevant improvement in ROM (= MIC) when there was an increase by ≥8° compared with the ROM preoperatively. Patients were satisfied with their postoperative ROM (= PASS) if they achieved PIP mobility of at least 66°. Pain at rest and during activities was predictive for achieving a MIC but not a PASS. Due to an insufficient area under the curve for the brief MHQ and ROM, their baseline values cannot predict the postoperative achievement of MIC or PASS. We suggest that patients with preoperative pain at rest ≥4.5 or pain during activities ≥5.5 have the greatest chance of achieving a subjectively relevant change 1 year after surgery. CONCLUSIONS The determined thresholds may support surgeons in the preoperative process of deciding for or against a surgical intervention and explain the probability of achieving sufficient postoperative symptom relief for the patient. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
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Affiliation(s)
- Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland.
| | - Michael Oyewale
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Schindele S, Oyewale M, Marks M, Brodbeck M, Herren DB. Three-Dimensionally Planned and Printed Patient-Tailored Plates for Corrective Osteotomies of the Distal Radius and Forearm. J Hand Surg Am 2024; 49:277.e1-277.e8. [PMID: 35985863 DOI: 10.1016/j.jhsa.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/10/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the 1-year postoperative clinical and patient-reported outcomes in patients who had a 3-dimensional planned corrective osteotomy of their distal radius, radial shaft, or ulnar shaft using a printed, anatomical, patient-tailored plate to determine the feasibility and effectiveness of this methodology. METHODS Simulations in computer-assisted preoperative planning of corrective osteotomies resulted in 3-dimensionally printed surgical guides, surgical models, and anatomically customized plates for application at the distal radius and forearm. Patients with malunions of the distal radius or forearm who underwent fixation with the custom-made plates were documented in our registry. Grip strength and range of motion assessments were made before surgery (baseline), as well as at 6 weeks and 3 and 12 months. Additionally, patients rated their wrist-related pain and disability using the Patient-Rated Wrist Evaluation. RESULTS Fifteen patients underwent corrective surgery, and the 1-year follow-up data of 14 patients with a median age of 56 years (interquartile range, 24-64 years) were available for analysis. The median baseline Patient-Rated Wrist Evaluation score improved from 47 to 7 after 1 year. The flexion-extension arc of motion of the wrist increased from 90° at baseline to 130° at 1 year and the pronation-supination arc of motion of the wrist increased from 135° to 160° in the same time period. Differences in radiological measurements for palmar and radial inclinations, as well as for ulnar variance between the affected and contralateral wrists, were reduced with the osteotomy. In 1 case, the plate was removed 11 months after the osteotomy. No severe adverse events were reported. CONCLUSIONS Three-dimensionally planned and printed patient-tailored plates offer a reliable method for correcting even complex malunions of the distal radius and forearm. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Michael Oyewale
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Michael Brodbeck
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland; Department of Hand and Elbow Surgery, Orthopädie Rosenberg, St. Gallen, Switzerland (present affiliation)
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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Neumeister S, Krefter C, Herren DB, Schindele S, Marks M. Are patients satisfied with online video consultations for assessing their hand disorder? Hand Surg Rehabil 2024; 43:101606. [PMID: 37827447 DOI: 10.1016/j.hansur.2023.09.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES The aim was to evaluate patient satisfaction with online video consultations in assessing hand disorder. MATERIAL AND METHODS This prospective study included patients who attended a video consultation, either as an initial meeting to assess the need for further evaluation or treatment or as an early postoperative follow-up consultation. After the consultation, they completed a satisfaction questionnaire. Regression models were used to reveal determinants of patient satisfaction. RESULTS We included 100 patients, with a mean age of 55 years (range 17-81 years). 95% were satisfied or very satisfied. The main reasons for choosing this form of consultation were shorter travel and wait times. Age, gender and educational level did not determine satisfaction. Significant factors for dissatisfaction were insufficient video and sound quality. CONCLUSION Online video consultation in hand surgery is a valuable alternative to in-clinic appointments for all age groups. However, it is crucial to ensure adequate video and audio quality.
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Affiliation(s)
- Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Caroline Krefter
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland.
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Neumeister S, Hagert E, Chung KC, Farnebo S, Boeckstyns M, Herren DB, Marks M. Revisions after trapeziometacarpal joint resection arthroplasty: A systematic literature review. Plast Reconstr Surg 2024:00006534-990000000-02237. [PMID: 38289903 DOI: 10.1097/prs.0000000000011323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND The aim of this systematic literature review was to describe current indications and interventions for revisions after trapeziometacarpal joint (TMJ) resection arthroplasty. METHODS The literature search was conducted by an experienced librarian in the Medline, EMBASE, Cochrane Library, Web of Science and Scopus databases. We included all articles that investigated any TMJ arthroplasty procedure in which the trapezium was completely resected and if any subsequent revision procedure including joint-related and soft-tissue surgeries was mentioned. Two independent reviewers selected the articles and were involved in data extraction. RESULTS Sixty-two articles reporting on 5,284 operated thumbs and 434 revision surgeries were included. We extracted 24 indications for revision and 31 revision techniques. Most revisions were performed because of subsidence/impingement of the first metacarpal bone (n=194 thumbs) followed by unspecified pain (n=53), metacarpophalangeal joint problems (n=28) and scaphotrapezoidal osteoarthritis (n=17). Eleven treatment strategies were found for subsidence/impingement of the first metacarpal, the most frequent being revision of the existing interposition using autologous tendon (n=46) and soft tissue interposition with distraction pinning (n=28). CONCLUSIONS There are a wide variety of indications and even more surgical techniques described in the literature to treat persisting or recurrent pain after TMJ resection arthroplasty. Currently, there is no uniform treatment guideline available how to diagnose and treat such cases. Therefore, the results of this literature review will form the basis for a Delphi study aiming to develop recommendations for the diagnosis and treatment of persistent / recurrent pain after TMJ resection arthroplasty. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden
| | - Kevin C Chung
- Comprehensive Hand Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery and Burns, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Startseva X, Marks M, Schweizer A, Herren DB, Schindele S. Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger? J Hand Surg Eur Vol 2023; 48:1056-1061. [PMID: 37751222 DOI: 10.1177/17531934231191255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The purpose of this study was to analyse the 1-year outcomes after combining a surface replacing proximal interphalangeal joint arthroplasty and a distal interphalangeal screw arthrodesis and to compare the combined surgery with proximal interphalangeal joint arthroplasty alone. To obtain two groups with similar baseline data from our prospective registry, propensity score matching was used to match 23 fingers with the combined operations with 115 fingers with proximal interphalangeal joint arthroplasty alone. One year after surgery, the mean ranges of motion were 60° (95% CI: 53° to 67°) in the combined group and 63° (95% CI: 60° to 66°) in the control group and did not differ significantly. Grip strength, the brief Michigan Hand Questionnaire and pain also did not differ between the groups 1 year after surgery. All the proximal interphalangeal implants in patients treated with a distal interphalangeal screw arthrodesis remained in situ. Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone.Level of evidence: III.
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Affiliation(s)
- Xenia Startseva
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Herren DB, Marks M, Neumeister S, Schindele S. Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2023; 48:1048-1055. [PMID: 37477211 DOI: 10.1177/17531934231188407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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Herren DB, Marks M, Neumeister S, Schindele S. Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty. J Hand Surg Eur Vol 2023; 48:877-883. [PMID: 37310049 DOI: 10.1177/17531934231179581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We analysed complications, revision surgeries, and patient-reported and clinical outcomes 2 years after trapeziometacarpal joint implant arthroplasty using the Touch® prosthesis. Of 130 operated patients with trapeziometacarpal joint osteoarthritis, four had to be revised owing to implant dislocation, loosening or impingement, leading to an estimated 2-year survival rate of 96% (95% confidence interval: 90 to 99). Of 101 patients available for the 2-year follow-up, complications occurred in 17, with the most frequent being de Quervain stenosing vaginosis (n = 6) and trigger thumb (n = 5). Pain at rest decreased significantly from a median value of 5 (interquartile range [IQR]: 4 to 7) before surgery to 0 (IQR: 0 to 1) at 2 years. Key pinch strength increased significantly from 4.5 kg (IQR: 3.0 to 6.5) to 7.0 kg (IQR: 6.0 to 8.0). We recommend surgery with the Touch® prosthesis as the standard procedure for patients with isolated trapeziometacarpal joint osteoarthritis because of the high survival rate and promising outcomes at 2 years.Level of evidence: IV.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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Herren DB, Oyewale M, Marks M. Is it useful to replace the proximal interphalangeal joint at the index finger? Analysis of prospective 5-year outcomes. J Hand Surg Eur Vol 2022; 47:1080-1082. [PMID: 36062414 DOI: 10.1177/17531934221121908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Michael Oyewale
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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Herren DB, Neumeister S, Marks M. Letter regarding "The Efficacy of Intra-Articular Versus Extra-Articular Corticosteroid Injections in the Thumb Carpometacarpal Joint". Journal of Hand Surgery Global Online 2022; 4:382. [DOI: 10.1016/j.jhsg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Herren DB, Verstreken F, Lluch A, Naqui Z, van der Heijden B. The impact of COVID-19 pandemic on hand surgery: a FESSH perspective. J Hand Surg Eur Vol 2022; 47:562-567. [PMID: 35414270 DOI: 10.1177/17531934221093925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Alex Lluch
- Hand & Wrist Unit, Vall d'Hebron Hospital and Institut Kaplan, Barcelona, Spain
| | - Zaf Naqui
- Department of Trauma, Orthopaedic and Plastic Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Brigitte van der Heijden
- Radboud University Medical Centre, Nijmegen, The Netherlands.,Jeroen Bosch Hospital's, Hertogenbosch, The Netherlands
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Grobet C, Audigé L, Eichler K, Meier F, Marks M, Herren DB. Cost-Utility Analysis of Thumb Carpometacarpal Resection Arthroplasty: A Health Economic Study Using Real-World Data. J Hand Surg Am 2022; 47:445-453. [PMID: 35346526 DOI: 10.1016/j.jhsa.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/10/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Knowledge about the costs and benefits of hand surgical interventions is important for surgeons, payers, and policy makers. Little is known about the cost-effectiveness of surgery for thumb carpometacarpal osteoarthritis. The objective of this study was to examine patients' quality of life and economic costs, with focus on the cost-utility ratio 1 year after surgery for thumb carpometacarpal osteoarthritis compared with that for continued nonsurgical management. METHODS Patients with thumb carpometacarpal osteoarthritis indicated for resection arthroplasty were included in a prospective study. The quality of life (using European Quality of Life-5 Dimensions-5 Level), direct medical costs, and productivity losses were assessed up to 1 year after surgery. Baseline data at recruitment and costs sustained over 1 year before surgery served as a proxy for nonsurgical management. The total costs to gain 1 extra quality-adjusted life year and the incremental cost-effectiveness ratio were calculated from a health care system and a societal perspective. RESULTS The mean European Quality of Life-5 Dimensions-5 Level value for 151 included patients improved significantly from 0.69 to 0.88 (after surgery). The productivity loss during the preoperative period was 47% for 49 working patients, which decreased to 26% 1 year after surgery. The total costs increased from US $20,451 in the preoperative year to US $24,374 in the postoperative year. This resulted in an incremental cost-effectiveness ratio of US $25,370 per quality-adjusted life year for surgery compared with that for simulated nonsurgical management. CONCLUSIONS The calculated incremental cost-effectiveness ratio was clearly below the suggested Swiss threshold of US $92,000, indicating that thumb carpometacarpal surgery is a cost-effective intervention. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analyses II.
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Affiliation(s)
- Cécile Grobet
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Flurina Meier
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland.
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Behm P, Marks M, Ferguson SJ, Brodbeck M, Herren DB. Intraoperative Load Tolerance of the Thumb Carpometacarpal Joint After Resection-Suspension-Interposition Arthroplasty. Journal of Hand Surgery Global Online 2022; 4:40-44. [PMID: 35415590 PMCID: PMC8991452 DOI: 10.1016/j.jhsg.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The objective was to measure the intraoperative load tolerance of the thumb carpometacarpal (CMC) joint after trapeziectomy, tendon suspension, and interposition. Methods In this single-center prospective study, preoperative pinch grip, thumb mobility, and hypermobility of the thumb CMC joint were determined by 2 hand surgeons. Patients completed the brief Michigan Hand Outcomes Questionnaire. During surgery and upon removal of the trapezium, the surgeon subjectively rated the degree of thumb CMC load tolerance as “stable,” “medium stable,” or “unstable.” A measurement system with an integrated force sensor was used to measure intraoperative thumb CMC load tolerance. The thumb ray was displaced manually by 10 mm toward the scaphoid, and the counteracting force was measured over the entire displacement. The objective load tolerance was determined as the maximal measured force after trapezium resection, tendon suspension, and interposition. Analysis of variance was used to test for the differences in load tolerance between the surgical steps. Spearman’s coefficient was used to find correlations between load tolerance and clinical or patient-reported variables. Results Twenty-nine patients with a mean age of 70 years (SD, 8.1 years) were available for analysis. The measured intraoperative load tolerance after trapeziectomy was 15.5 N (SD, 5.4 N) and significantly increased to 18.7 N (SD, 5.5 N) after suspension. Load tolerance only slightly increased after tendon interposition, increasing the force to 20.3 N (SD, 6.7 N). Neither the surgeon’s subjective stability rating nor the clinical or patient-reported variables correlated with the measured load tolerance after trapeziectomy. Conclusions Our results show that tendon suspension leads to the highest increase in thumb CMC load tolerance during resection-suspension-interposition arthroplasty. Clinical relevance Tendon suspension appears to be the most important step in stabilizing the metacarpal base after trapeziectomy, whereas tendon interposition does not seem to have a relevant additional effect regarding load tolerance, at least immediately after surgery.
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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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Abstract
This study investigated revision surgery for the thumb after failed trapeziectomy with ligament reconstruction and tendon interposition and defined a revision concept. Twenty-four patients with 25 affected thumbs were examined at a mean of 5.5 years after their last revision operation. Pain during daily activities was 2.7 on a 0-10 numeric rating scale, pain at rest was 1.6 and the brief Michigan Hand Outcomes Questionnaire score was 63. Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition. We defined a revision algorithm to use as a guide for patients with residual symptoms after resection arthroplasty. The main reason for revision, symptomatic impingement of the thumb metacarpal, should be treated with resection of the metacarpal base and scaphotrapezoidal joint. An existing interposition should be revised, or a new interposition should be used, preferably with an autologous tendon or alternately with an allograft.Level of evidence: IV.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Nina Fuchs
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland *Both authors equally contributed to this paper
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Labèr R, Oyewale M, Herren DB. Bioabsorbable poly-L/D-lactide (96/4) scaffold arthroplasty as a salvage procedure in the metacarpophalangeal joint. Hand Surg Rehabil 2021; 41:149-151. [PMID: 34781001 DOI: 10.1016/j.hansur.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
We report the case of a 69-year-old female patient, who developed an impressive foreign body reaction around broken metacarpophalangeal silicone implants, including serious axillary lymphadenopathy 3 years after surgery. Possible revision arthroplasties were evaluated but, due to poor bone stock, no regular implants could be used. Instead, a double RegJoint™ (Scaffdex Oy, Finland), a bioabsorbable poly-L/D-lactide implant, was used for each of the 4 metacarpophalangeal joints. At follow-up, we observed no recurrence of synovitis, lymphadenopathy, or any other adverse events. The patient was highly satisfied with the results of the surgery, and painless functional joint movement could be achieved. The restorable RegJoint™ implant seems to be a valid revision option in case of failed silicone arthroplasty.
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Affiliation(s)
- Raffael Labèr
- Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
| | - Michael Oyewale
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
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Reischenböck V, Marks M, Herren DB, Schindele S. Surface replacing arthroplasty of the proximal interphalangeal joint using the CapFlex-PIP implant: a prospective study with 5-year outcomes. J Hand Surg Eur Vol 2021; 46:496-503. [PMID: 33270488 DOI: 10.1177/1753193420977244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this prospective study was to evaluate the 5-year outcomes in patients after proximal interphalangeal joint arthroplasty using the surface replacing implant, CapFlex-PIP. Ninety-two prosthesis were implanted and 65 patients with 68 implants were available for follow-up. The brief Michigan Hand Outcomes Questionnaire score improved significantly from 45 (SD 15) before surgery to 71 (SD 17) at 5 years. On the numeric rating scale, pain during activities decreased significantly from 6.4 (SD 1.9) to 1.8 (SD 1.9). Range of motion of the joints increased significantly from 45° (SD 21) to 54° (SD 24). An axis deviation of more than 5° was found in 65% of the joints before surgery, but only in 25% at 5 years. Soft tissue reoperations were performed on eight patients. Four out of 92 implants underwent revision for stiffness or implant loosening. In three implants, the distal component migrated without needing revision. Overall, the CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint.Level of evidence: IV.
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Affiliation(s)
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Neukom L, Marks M, Hensler S, Kündig S, Herren DB, Schindele S. Silicone arthroplasty versus screw arthrodesis in distal interphalangeal joint osteoarthritis. J Hand Surg Eur Vol 2020; 45:615-621. [PMID: 32338192 DOI: 10.1177/1753193420917818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate patient satisfaction after distal interphalangeal joint silicone arthroplasty and compare this outcome to that achieved with screw arthrodesis. On average 4.4 years after surgery, range of motion of the distal interphalangeal joint, pain on a numeric rating scale, satisfaction, and hand appearance of 48 patients (78 treated fingers) were assessed. For arthroplasty patients, mean distal interphalangeal joint motion was 28° with an extension deficit of 17°. Pain was low for arthroplasty and arthrodesis patients with scores of 0.2 and 0.6 out of a total of 10 points, respectively. The patients in both groups were satisfied with their outcomes, but arthroplasty patients were less satisfied with the appearance. Twenty-one per cent of the arthroplasties and 15% of the arthrodeses underwent reoperation. We suggest the motion-preserving distal interphalangeal arthroplasty as an alternative to distal interphalangeal arthrodesis for patients with higher functional demands and whose joints are stable preoperatively. In patients attaching importance to hand aesthetics and for unstable joints, distal interphalangeal joint arthrodesis is preferable. Level of evidence: III.
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Affiliation(s)
- Lisa Neukom
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stefanie Hensler
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sylvia Kündig
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Bodmer E, Marks M, Hensler S, Schindele S, Herren DB. Comparison of outcomes of three surgical approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant. J Hand Surg Eur Vol 2020; 45:608-614. [PMID: 31813305 DOI: 10.1177/1753193419891382] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective was to compare outcomes of the volar, Chamay and tendon splitting approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant (CapFlex-PIP). One-hundred prospectively documented patients with a 2-year follow-up were included. Range of proximal interphalangeal joint motion, the brief Michigan Hand Outcomes Questionnaire and complications were analysed. Between baseline and follow-up, mean proximal interphalangeal joint motion increased for the volar (53° to 54°), Chamay (38° to 53°) and tendon splitting (40° to 61°) approaches. The volar approach yielded the greatest flexion and the highest extension deficit. The mean brief Michigan Hand Outcomes Questionnaire scores at baseline and 2 years were 45 and 74 (volar), 45 and 66 (Chamay) and 41 and 75 (tendon splitting). Seven patients in the Chamay group and two in the volar group required a reoperation consisting of teno-/arthrolysis. The tendon splitting approach tended to result in the best outcomes that were associated with fewer complications compared with the volar and Chamay approaches. Level of evidence: IV.
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Affiliation(s)
- Elvira Bodmer
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stefanie Hensler
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Abstract
The severity of preoperative symptoms at which patients are likely to achieve a minimal important change and patient acceptable symptom state after surgery may help the decision to perform surgery for trapeziometacarpal osteoarthritis. The study objective was to define these thresholds for pain at rest and during activities as well as for the brief Michigan Hand Outcomes Questionnaire. One hundred and fifty-one patients were examined before surgery and 3, 6 and 12 months after surgery. The minimal important change after surgery was 1.9, 3.9 and 16 scores for pain at rest, pain during activities and the brief Michigan Hand Outcomes Questionnaire, respectively. The respective patient acceptable symptom state values were 1.5, 2.5 and 70 after surgery. Our results show that patients with baseline pain values between 3.5 and 5.5 at rest, between 6.5 and 7.5 during activities and a presurgery brief Michigan Hand Outcomes Questionnaire score of about 47, have the greatest chance of achieving a relevant symptom change and an acceptable symptom state. The information from this study may help surgeons in deciding the surgical indications and help patients in their expectation in symptom relief after surgery. Level of evidence: IV.
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Affiliation(s)
- Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Cécile Grobet
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Affiliation(s)
- Stephan Schindele
- 1 Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- 2 Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- 1 Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Marks M, Hensler S, Wehrli M, Schindele S, Herren DB. Minimal important change and patient acceptable symptom state for patients after proximal interphalangeal joint arthroplasty. J Hand Surg Eur Vol 2019; 44:175-180. [PMID: 30217122 DOI: 10.1177/1753193418799568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Our aim was to determine the minimal important change and patient acceptable symptom state for pain and the brief Michigan Hand Outcomes Questionnaire in patients 1 year after proximal interphalangeaI joint arthroplasty. We analysed data of 100 patients from our prospective registry. The minimal important change and patient acceptable symptom state were determined with anchor-based methods, and patients with better or worse baseline status were examined. The minimal important change for pain at rest and during activities, and the brief Michigan Hand Outcomes Questionnaire was -1.2, -2.8 and 18, respectively, with corresponding patient acceptable symptom state values of 1.5, 2.5 and 64. Patients with higher baseline symptoms rated more severe postoperative symptoms as acceptable, whereas patients with lower baseline symptoms were only satisfied with a low level of pain and high level of hand function. The minimal important change and patient acceptable symptom state are useful estimates for patient outcomes and study results. Level of evidence: IV.
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Affiliation(s)
- Miriam Marks
- 1 Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stefanie Hensler
- 1 Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Martina Wehrli
- 1 Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stephan Schindele
- 2 Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- 2 Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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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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Marks M, Hensler S, Wehrli M, Scheibler AG, Schindele S, Herren DB. Trapeziectomy With Suspension-Interposition Arthroplasty for Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial Comparing the Use of Allograft Versus Flexor Carpi Radialis Tendon. J Hand Surg Am 2017; 42:978-986. [PMID: 28899589 DOI: 10.1016/j.jhsa.2017.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/01/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft). METHODS We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded. RESULTS We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46-56) to 83 (95% CI, 78-87) and 53 (95% CI, 47-58) to 76 (95% CI, 69-84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient. CONCLUSIONS The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Miriam Marks
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland.
| | - Stefanie Hensler
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland
| | - Martina Wehrli
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Marrel M, Jörn Good U, Marks M, Herren DB, Goldhahn J. Isoforce: A new outrigger system for static progressive orthotic interventions of the proximal interphalangeal joint with constant force transmission-Results of a biomechanical study. J Hand Ther 2017; 29:451-458. [PMID: 27769842 DOI: 10.1016/j.jht.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/29/2016] [Accepted: 05/11/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Bench research-biomechanical study. INTRODUCTION Static progressive orthotic devices are efficient in treating contractures. However, current outriggers are unable to keep force transmission and the force application angle (FAA) constant. PURPOSE OF THE STUDY To evaluate the biomechanical performance of the Isoforce outrigger, a novel extension orthosis. METHODS A hand model was used to measure the required force at the outrigger and FAA, while simulating resolution of different contracture angles. We also tested feasibility in a small patient series. RESULTS The force required with the Isoforce device never exceeded 2.4 N, and the FAA did not change more than 6°. Corresponding figures for the reference devices exceeded 16 N and 20°. The 7 patients testing the Isoforce extension device showed an extension deficit that decreased from 40° at baseline to 25° at 6 weeks. They rated the device as very comfortable to wear. CONCLUSIONS Isoforce maintains constant force transmission and FAA throughout the full range of motion, promotes the lengthening of contracted structures, and is comfortable to wear. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Marion Marrel
- Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Ulla Jörn Good
- Department of Occupational Therapy, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Upper Extremities and Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Jörg Goldhahn
- Institute for Biomechanics, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.
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Krefter C, Marks M, Hensler S, Herren DB, Calcagni M. Complications after treating Dupuytren's disease. A systematic literature review. Hand Surg Rehabil 2017; 36:322-329. [PMID: 28917432 DOI: 10.1016/j.hansur.2017.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 12/23/2022]
Abstract
The objective of this study was to review the incidence of complications associated with different treatment options for patients with Dupuytren's disease. In a systematic literature review, the PubMed, EMBASE, Cochrane and Scopus databases were searched for clinical studies reporting complications after collagenase treatment, percutaneous needle fasciotomy (PNF), fasciectomy and dermofasciectomy. The incidence of complications was extracted from each study and stratified by procedure. From a total of 2251 references, 113 studies were analyzed and included with complication incidences varying from 0% to 100%. The highest number of nerve and vessel lesions were reported after fasciectomy, whereas the highest rate of edema was after collagenase injection. Accidental skin tears were mostly associated with collagenase and PNF treatment. Pooled complication incidences were 17.4% (95% CI: 11.7-23.1) for fasciectomy, 78.0% (95% CI: 59.6-96.4) for collagenase treatment, 18.9% (95% CI: -5.5-43.3) for PNF and 11.6% (95% CI: 0.0-23.2) for dermofasciectomy. Due to inconsistencies in reporting complications as well as the lack of a standardized definition, the literature does not provide evidence in favor of a specific procedure for Dupuytren's disease. A standardized definition of complications is required to improve the comparability of published results.
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Affiliation(s)
- C Krefter
- Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - M Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - S Hensler
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - D B Herren
- Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Abstract
There are increasing numbers of proximal interphalangeal (PIP) arthroplasties performed in Europe. Meanwhile, most surgeons prefer arthroplasty over arthrodesis. Silastic arthroplasties remain the most widely used implants. The main disadvantage of the Silastic implants is the limited stability they provide. Correction of pre-existing deformation is difficult. Soft tissue handling and postoperative scarring have an influence on the results of PIP arthroplasty. Different surgical approaches are possible. The most popular approach in Europe is dorsal. Different surface replacement implants are on the market in Europe. The main advantage of these implants is the lateral stability provided through their more anatomic form.
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Affiliation(s)
- Daniel B Herren
- Hand Surgery Department, Schulthess Klinik, Lenggahlde 2, Zurich 8008 CHE, Switzerland.
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Marti C, Hensler S, Herren DB, Niedermann K, Marks M. Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release. J Hand Surg Eur Vol 2016; 41:957-962. [PMID: 27435748 DOI: 10.1177/1753193416659404] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The objective of this study was to investigate the measurement properties of the EuroQol EQ-5D-5L questionnaire (EQ-5D-5L). A total of 60 patients with carpal tunnel syndrome completed the EQ-5D-5L twice before surgical decompression and once more 6 weeks after surgery. In addition, they filled out the Short Form 12 and Michigan Hand Outcomes Questionnaire at the baseline and postoperative follow-up examinations. Test-retest reliability was excellent with an intraclass correlation coefficient of 0.81. Internal consistency was high with Cronbach's alpha of 0.83. Good validity of the EQ-5D-5L was indicated by correlations of r = 0.7 and r = 0.5 with the Short Form 12 and Michigan Hand Outcomes Questionnaire, respectively. Moderate responsiveness was shown by an effect size of 0.5. The minimal important change was 0.09 points. Overall, the EQ-5D-5L demonstrates sound measurement properties and can be recommended as a suitable tool to assess quality of life in patients with carpal tunnel syndrome. LEVEL OF EVIDENCE I.
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Affiliation(s)
- C Marti
- 1 Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
- 2 Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - S Hensler
- 1 Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - D B Herren
- 3 Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - K Niedermann
- 2 Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - M Marks
- 1 Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
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Wehrli M, Hensler S, Schindele S, Herren DB, Marks M. Measurement Properties of the Brief Michigan Hand Outcomes Questionnaire in Patients With Dupuytren Contracture. J Hand Surg Am 2016; 41:896-902. [PMID: 27469936 DOI: 10.1016/j.jhsa.2016.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ. METHODS Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined. RESULTS The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and -0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points. CONCLUSIONS Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture. CLINICAL RELEVANCE The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment.
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Affiliation(s)
- Martina Wehrli
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland; Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland.
| | - Stefanie Hensler
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
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Abstract
BACKGROUND/OBJECTIVE The objective of this study was to investigate what treatment options are currently used in Switzerland for Dupuytren's disease. Furthermore, regional preferences and treatment differences based on surgeon experience were analysed. MATERIAL AND METHODS In this survey, an electronic questionnaire was sent to all members of the Swiss Society for Hand Surgery. Participants were asked to indicate their current treatment methods for Dupuytren's disease. In addition, 8 standard patient cases were presented to identify the preferred treatment option. Furthermore, sociodemographic data of the participants were gathered. RESULTS In total, 70 questionnaires were completed, corresponding to a response rate of 34%. Fasciectomy is performed by 94% of participants, while 59% inject collagenase in certain cases, 40% perform open fasciotomy, and 24% carry out percutaneous needle aponeurotomy if the indication is given. 20% of responders offer one of these techniques, 50% offer 2, 23% offer 3, and 7% offer all 4 treatment techniques. In the case of isolated metacarpophalangeal joint contracture, 51% of participants inject collagenase, whereas fasciectomy is preferred for the treatment of proximal interphalangeal joint contractures or in cases of recurrence. In German-speaking Switzerland, the treatment strategy has changed towards applying collagenase injections in the past 5 years. In this part of the country, 83% of surgeons now use more collagenase than 5 years ago, whereas only 33% of surgeons in French-speaking Switzerland have changed their treatment strategy in favour of collagenase injections (p=0.027). Surgeons with less than 10 years of experience apply more collagenase than their more experienced colleagues (79 vs. 54%, p=0.131). CONCLUSIONS In Switzerland, fasciectomy is the preferred option for treating patients with Dupuytren's disease. In recent years, however, collagenase injection has become more and more popular. More research is needed to define guidelines for the treatment of patients with Dupuytren's disease considering the effectiveness of the different treatment options and regional preferences.
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Affiliation(s)
- M Marks
- Schulthess Klinik, Abteilung für Lehre, Forschung und Entwicklung, Zürich, Schweiz
| | - C Krefter
- Schulthess Klinik, Handchirurgie, Zürich, Schweiz
| | - D B Herren
- Schulthess Klinik, Handchirurgie, Zürich, Schweiz
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Reissner L, Marks M, Schindele S, Herren DB. Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition. J Hand Surg Eur Vol 2016; 41:335-9. [PMID: 26637826 DOI: 10.1177/1753193415616959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/29/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of our study was to investigate if pre- and postoperative radiographic thumb carpometacarpal position is correlated with clinical and subjective outcomes. Radiographs of 105 patients undergoing trapeziectomy with ligament reconstruction and tendon interposition were analysed before, as well as 1 year after, surgery for dorsal subluxation and proximal migration of the thumb metacarpal bone. Furthermore, key pinch strength was measured and patients completed the Michigan Hand Outcomes Questionnaire. Baseline dorsal subluxation and scaphometacarpal distances significantly decreased from 8.2 mm and 11.0 mm to 5.2 mm and 5.1 mm at 1 year, respectively. There was no correlation between the amount of subluxation or proximal migration and the Michigan Hand Outcomes Questionnaire score or key pinch strength. These results suggest that postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon reposition of the thumb carpometacarpal joint. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- L Reissner
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - M Marks
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - S Schindele
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - D B Herren
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
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Marks M, Vliet Vlieland TPM, Audigé L, Herren DB, Nelissen RGHH, van den Hout WB. Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2015; 40:927-34. [PMID: 25646143 DOI: 10.1177/1753193414568293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/04/2014] [Indexed: 02/03/2023]
Abstract
The objective of this study was to analyse healthcare and productivity costs in patients with trapeziometacarpal osteoarthritis. We included 161 patients who received surgery or steroid injection and calculated their healthcare costs in Euro (€) over 1 year. Patients filled out the Work Productivity and Activity Impairment Questionnaire to assess loss of productivity at baseline, and after 3, and 12 months. In the surgical group, loss of productivity among employed patients first increased and then decreased (50%, 64%, and 25% at 0, 3, and 12 months). Productivity was more stable over time in the injection group (52%, 38%, and 48%). In the surgical group, estimated total annual healthcare and productivity costs were €5770 and €5548, respectively. In the injection group, healthcare and productivity costs were €348 and €3503. These findings highlight the need for assessing productivity costs to get a comprehensive view of the costs associated with a treatment.Level of Evidence III.
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Affiliation(s)
- M Marks
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - L Audigé
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - D B Herren
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - W B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Hensler S, Herren DB, Marks M. New technical design of food packaging makes the opening process easier for patients with hand disorders. Appl Ergon 2015; 50:1-7. [PMID: 25959312 DOI: 10.1016/j.apergo.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
Opening packaged food is a complex daily activity carried out worldwide. Peelable packaging, as used for cheese or meat, causes real problems for many consumers, especially elderly people and those with hand disorders. Our aim was to investigate the possibility of producing meat packaging that is easier for patients with hand disorders to open. One hundred patients with hand osteoarthritis were asked to open a meat package currently available in supermarkets (Type A) and a modified, newly designed version (Type B), and rate their experiences with a consumer satisfaction index (CSI). The mean CSI of the Type B packs was 68.9%, compared with 41.9% for Type A (p < 0.0001). These results show that manufacturers today can produce easy-to-open food packages that afford greater consumer satisfaction. Such future packaging would benefit not only people with hand disorders but also the population as a whole.
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Affiliation(s)
- Stefanie Hensler
- Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
| | - Daniel B Herren
- Department of Upper Extremities and Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Miriam Marks
- Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
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Frouzakis R, Herren DB, Marks M. Evaluation of expectations and expectation fulfillment in patients treated for trapeziometacarpal osteoarthritis. J Hand Surg Am 2015; 40:483-90. [PMID: 25617218 DOI: 10.1016/j.jhsa.2014.10.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the main reasons why patients with trapeziometacarpal osteoarthritis (TMC OA) seek treatment, their pretreatment expectations for the final outcome, fulfillment after one year, and predictors of fulfillment of the expectation. METHODS We included 163 patients with TMC OA. They filled out questionnaires assessing expectations and functional status before and at 3, 6, and 12 months after treatment. RESULTS Pain reduction was the most important reason why 65% of all patients sought treatment, whereas 17% and 13% requested treatment to improve hand function and activities of daily living, respectively. No patients considered improved appearance of the hand to be the main reason for undertaking treatment. Expectations before treatment were anticipated to be totally or mostly fulfilled by 93% of surgically treated patients and 59% of patients treated with corticosteroid injection. After one year, 77% of surgically treated patients rated their expectations as completely or mostly fulfilled, compared with 24% of patients treated with corticosteroid injections. Including all variables before treatment in a best-fit regression model, fulfillment of patients' expectations could not be sufficiently predicted. However, with addition to the model of the outcome of pain at one year, 48% of the variance of fulfilled expectations could be accounted for. CONCLUSIONS Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. Based on variables before treatment, no prediction can be made regarding whether expectations will be fulfilled after treatment because residual pain at one year contributes considerably to the variance in fulfilled expectations. Clinicians should assess patients' expectations before treatment and explain realistic treatment outcomes to obtain best treatment results. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Regula Frouzakis
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland; Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel B Herren
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland; Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Miriam Marks
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland; Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
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Schindele SF, Hensler S, Audigé L, Marks M, Herren DB. A modular surface gliding implant (CapFlex-PIP) for proximal interphalangeal joint osteoarthritis: a prospective case series. J Hand Surg Am 2015; 40:334-40. [PMID: 25510157 DOI: 10.1016/j.jhsa.2014.10.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the one-year postoperative clinical and patient-rated outcomes in patients receiving proximal interphalangeal (PIP) joint arthroplasty with a modular surface gliding implant, CapFlex-PIP. METHODS 10 patients each with primary osteoarthritis of a single PIP joint were assessed preoperatively (baseline), at 6 weeks, and 3, 6, and 12 months after CapFlex-PIP arthroplasty for lateral stability and range of motion of the affected digit. In addition, patients rated their pain using a numeric rating scale and function and overall assessment of their treatment and condition using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Evaluation Measure (PEM) questionnaires, respectively. RESULTS The mean baseline active mobility of the affected PIP joint increased from 42° to 51° by one year, although this change was not significant. Patients reported reduced pain at one year, which was statistically significant. There was also a significant improvement between baseline and one-year QuickDASH (43 points vs 15 points, respectively) and PEM scores (51 vs 25 points, respectively). Absent or low lateral instability was observed in 9 joints at follow-up. All implants remained intact over the one-year postoperative period and there was no migration, osteolysis, or implant fracture. After study completion, 2 patients underwent tenolysis. CONCLUSIONS Patients experienced a significant reduction in pain and a trend towards increased mobility. All implants showed complete osteointegration without evidence of radiological migration. Lateral stability improved. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Stephan F Schindele
- Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
| | - Stefanie Hensler
- Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Laurent Audigé
- Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Miriam Marks
- Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Daniel B Herren
- Department of Upper Extremities and Hand Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
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Marks M, Audigé L, Reissner L, Herren DB, Schindele S, Vliet Vlieland TPM. Determinants of patient satisfaction after surgery or corticosteroid injection for trapeziometacarpal osteoarthritis: results of a prospective cohort study. Arch Orthop Trauma Surg 2015; 135:141-7. [PMID: 25412881 DOI: 10.1007/s00402-014-2119-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The evaluation of patient satisfaction is becoming increasingly important in assessing treatment outcomes. The objective of this study was to analyze the determinants of treatment satisfaction in patients with trapeziometacarpal osteoarthritis (TMC OA) after surgery or corticosteroid injection. MATERIALS AND METHODS Prospective cohort study of patients with TMC OA who received surgery or corticosteroid injection was carried out. Socio-demographic and clinical data were recorded at baseline and 1 year after the intervention, and patients filled out the Michigan Hand Outcomes Questionnaire (MHQ). On a 5-point Likert scale, patients reported baseline expectations, expectation fulfillment at 1 year, as well as satisfaction with the treatment result. To identify determinants of satisfaction, we entered these variables into one ordered logistic regression model for surgical patients and another for patients with injection. RESULTS We included 146 patients, 88 of whom were treated surgically. With respect to satisfaction at 1 year, 87 % of the surgical patients were somewhat or very satisfied with the treatment result, whereas only 49 % of the patients with injection were satisfied. Expectations being fulfilled was the only determinant of treatment satisfaction in the surgical group. In the injection group, a more advanced Eaton stage of TMC OA and greater pain at 1 year were associated with reduced satisfaction. CONCLUSIONS Surgery for TMC OA leads to high patient satisfaction, whereas only half of the patients treated with corticosteroid injection were satisfied with the treatment result. An advanced stage of TMC OA and higher pain lead to reduced treatment satisfaction in the latter group, indicating that corticosteroid injection is only effective for patients in a lower stage of disease. As fulfillment of expectations was an important determinant of satisfaction in the surgical group, we emphasize the need to provide comprehensive information prior to surgery, so that the patient's expectations of treatment outcome are realistic.
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Affiliation(s)
- Miriam Marks
- Department of Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland,
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Abstract
Results of anatomical resurfacing of the proximal interphalangeal joint using pyrocarbon implants showed reasonable clinical results with a high radiographic migration rate. The aim was to investigate the subjective, clinical, and radiographic results 10 years following surgery, and to compare them with our 2-year follow-up data. We re-evaluated 12 patients with 15 proximal interphalangeal implants on average 9.7 years after surgery. Pain significantly improved from 7.6 on a visual analogue scale pre-operatively to 1.4 at 2 years, and to 0.7 at the final follow-up. The mean total range of motion in all replaced joints was 36° pre-operatively and 39° at the 2-year follow-up, but had decreased significantly to 29° at 10 years. We saw one implant migration in addition to the eight migrated implants we already found 2 years after surgery. The moderate clinical results, combined with the high migration rate, mean that we no longer use this kind of implant.
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Affiliation(s)
- L Reissner
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - S Schindele
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
| | - S Hensler
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - M Marks
- Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - D B Herren
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
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Herren DB, Keuchel T, Marks M, Schindele S. Revision arthroplasty for failed silicone proximal interphalangeal joint arthroplasty: indications and 8-year results. J Hand Surg Am 2014; 39:462-6. [PMID: 24503230 DOI: 10.1016/j.jhsa.2013.11.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the indications for revision of silicone proximal interphalangeal joint arthroplasties, to analyze the results of revision surgery, and to determine which specific patient concerns were most successfully addressed by revision surgery. METHODS This study combined a cross-sectional evaluation of the patients' condition after revision surgery and a retrospective chart review. All patients who had revision surgery of their PIP silicone arthroplasty in our clinic between 1999 and 2009 were invited for clinical follow-up. We reviewed their medical records, took radiographs, and recorded the active flexion and extension, pain, and patient satisfaction. RESULTS Thirty-four revisions in 27 patients were performed, and we were able to examine 20 patients with 24 arthroplasties clinically. The average follow-up was 4.3 years after revision and 8.3 years following primary surgery. The main indications for revision surgery were pain and restricted active range of motion, with or without implant breakage, predominantly in the index and middle fingers. Patients were fairly satisfied with the outcome of the revision surgery and reported only mild residual pain. Patients whose indication for revision was a restricted active range of motion increased active flexion from 33° before the revision to 71° following the operation. Patients who required revision for a large ulnar deviation deformity (mean, 33°) still had a residual deviation of 15° at follow-up. CONCLUSIONS Revision surgery after failed silicone proximal interphalangeal joint arthroplasty was most successful in patients with severe postoperative stiffness. Pain was relieved, and patients were fairly satisfied with the results of the revision. Ulnar deviation could not be corrected completely. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Daniel B Herren
- Department of Upper Extremities and Hand Surgery and the Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
| | - Tina Keuchel
- Department of Upper Extremities and Hand Surgery and the Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Miriam Marks
- Department of Upper Extremities and Hand Surgery and the Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Stephan Schindele
- Department of Upper Extremities and Hand Surgery and the Department of Research and Development, Schulthess Clinic, Zurich, Switzerland
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Marks M, Audigé L, Herren DB, Schindele S, Nelissen RGHH, Vliet Vlieland TPM. Measurement Properties of the German Michigan Hand Outcomes Questionnaire in Patients With Trapeziometacarpal Osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66:245-52. [DOI: 10.1002/acr.22124] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/09/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Miriam Marks
- Schulthess Klinik; Zurich Switzerland
- Leiden University Medical Center; Leiden The Netherlands
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Marks M, Schoones JW, Kolling C, Herren DB, Goldhahn J, Vliet Vlieland TPM. Outcome measures and their measurement properties for trapeziometacarpal osteoarthritis: a systematic literature review. J Hand Surg Eur Vol 2013; 38:822-38. [PMID: 23649014 DOI: 10.1177/1753193413488301] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective was to identify all outcome measures used in studies on trapeziometacarpal osteoarthritis (TMC OA) and evaluate their measurement properties. In a two-step systematic literature review, we first identified studies including TMC OA patients and extracted all outcome measures. They were categorized according to the Outcome Measures in Rheumatology (OMERACT) core set for OA including five dimensions: pain, physical function, global assessment, imaging, and quality of life (QoL). Secondly, we retrieved articles on the measurement properties of the identified outcome measures for TMC OA patients. First, 316 articles including 101 different outcome measures were identified, addressing the OMERACT pain and function domains most frequently but under-representing QoL. Second, 12 articles investigating measurement properties of 12 outcome measures were identified. The methodological quality of these studies was poor to fair, implying that based on the literature no recommendations to use any of the outcome measures can yet be made.
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Affiliation(s)
- M Marks
- Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
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Abstract
Tendon involvement in rheumatoid arthritis is frequent and might even be the first sign of the disease. In long-standing untreated conditions, especially in combination with bony erosions, tenosynovitis may lead to tendon fraying and finally tendon rupture. Tendon reconstruction includes tendon grafting and tendon transfer. Direct repair is almost never possible in patients with rheumatoid arthritis, because the inflammatory process produces extensive tendon damage over a long distance. In patients with significant impaired joint function, additional joint treatment should be planned at the same time as tendon reconstruction.
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Affiliation(s)
- Stephan F Schindele
- Department of Upper Extremity and Handsurgery, Schulthess Clinic, Lengghalde 2, CH-8008 Zurich, Switzerland.
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Angst F, Drerup S, Werle S, Herren DB, Simmen BR, Goldhahn J. Prediction of grip and key pinch strength in 978 healthy subjects. BMC Musculoskelet Disord 2010; 11:94. [PMID: 20482832 PMCID: PMC2882344 DOI: 10.1186/1471-2474-11-94] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 05/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the predictive power of cofactors and to predict population-based normative grip and pinch strength. METHODS A representative population survey was used as the basis for prediction analyses (n = 978). Bivariate relationships between grip/pinch strengths of the dominate hand were explored by means of all relevant mathematical functions to maximize prediction. The resulting best functions were combined into a multivariate regression. RESULTS Polynoms (up to the third degree) were the best predictive functions. On the bivariate level, height was best correlated to grip (46.2% explained variance) and pinch strength (37.7% explained variance) in a linear relationship, followed by sex, age, weight, and occupational demand on the hand. Multivariate regression provided predicted values close to the empirical ones explaining 76.6% of the variance for grip strength and 67.7% for pinch strength. CONCLUSION The five easy-to-measure cofactors sex, age, body height, categorized occupational demand on the hand, and body weight provide a highly accurate prediction of normative grip and pinch strength.
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Affiliation(s)
- Felix Angst
- Department of Upper Extremity and Hand Surgery, Schulthess Klinik, Lengghalde 2, Zurich, Switzerland.
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Kolling C, Herren DB, Simmen BR, Goldhahn J. Changes in surgical intervention patterns in rheumatoid arthritis over 10 years in one centre. Ann Rheum Dis 2009; 68:1372-3. [PMID: 19605747 DOI: 10.1136/ard.2008.100800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol 2009; 34:76-84. [PMID: 19129352 DOI: 10.1177/1753193408096763] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Assessment of hand strength is used in a wide range of clinical settings especially during treatment of diseases affecting the function of the hand. This investigation aimed to determine age- and gender-specific reference values for grip and pinch strength in a normal Swiss population with special regard to old and very old subjects as well as to different levels of occupational demand. Hand strength data were collected using a Jamar dynamometer and a pinch gauge with standard testing position, protocol and instructions. Analysis of the data from 1023 tested subjects between 18 and 96 years revealed a curvilinear relationship of grip and pinch strength to age, a correlation to height, weight and significant differences between occupational groups. Hand strength values differed significantly from those of other populations, confirming the thesis that applying normative data internationally is questionable. Age- and gender-specific reference values for grip and pinch strength are presented.
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Affiliation(s)
- S Werle
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland.
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Simmen BR, Angst F, Schwyzer HK, Herren DB, Pap G, Aeschlimann A, Goldhahn J. A concept for comprehensively measuring health, function and quality of life following orthopaedic interventions of the upper extremity. Arch Orthop Trauma Surg 2009; 129:113-8. [PMID: 18784930 DOI: 10.1007/s00402-008-0718-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Indexed: 11/27/2022]
Abstract
The view that subjective complaints rather than "objective" measurements decide on whether to consult the doctor or allow for an intervention to be carried out, should contribute to the decision-making process. This is especially true in diseases with multiple joint impairments. Although a variety of patient self-assessment scores exists, no gold standard is available to measure function and quality of life (QoL) after interventions at the upper extremity. The goal of our concept is to establish a comprehensive score set where patients should rate their generic health resp. quality of life (QoL), function of the upper extremity and specific joint function including activities of daily living, function and pain. A comparison with normative data should be possible in order to estimate how the subjective results of the patient when compared to "healthy" people in the general population. Score sets for measuring intervention effect at the shoulder, elbow and the hand were established after previous methodological testing within an interdisciplinary research project. The provisional sets were defined following a systematic literature search. Each set received a score of measuring the quality of life (SF-36), the whole function of the arm (DASH) and the specific joint function (SPADI/ASES for shoulder, PREE/mASES for the elbow and PRWE/custom for the hand). Individual scores were translated, if necessary according to AAOS-guidelines, and tested for reliability and construct validity. All three score sets were then systematically tested in cross-sectional studies. In addition, characteristic values such as minimal detectable difference and effect size could already be determined in the shoulder set in a long-term study. Definite score sets were defined, which allow quantification of the intervention effect at the upper extremity on function and quality of life after.
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Affiliation(s)
- Beat R Simmen
- Upper Extremity/Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Abstract
Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p <or= 0.001), an 18% increase in Tb.Th (p = 0.006), and a 10% greater Tb.N (p = 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (+67% BV/TV, +20% Tb.Th, +23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives.
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Affiliation(s)
- Philipp Nufer
- Musculosceletal Research, Schulthess Klinik, Lengghalde 2, CH-8008 Zürich, Switzerland
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Abstract
The correct treatment of wrist deformation in the patient who has rheumatoid arthritis has a major impact on the preservation of function of the hand. Surgical decisions should be individualized, based on the patient's needs and the future development of deformation. Partial wrist arthrodesis in rheumatoid wrists is an excellent tool to preserve stability and functional mobility in the long term. In cases of severe destruction complete wrist fusion should be considered alternatively.
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Affiliation(s)
- Daniel B Herren
- Handsurgery Department, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
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Kistler U, Weiss APC, Simmen BR, Herren DB. Long-term results of silicone wrist arthroplasty in patients with rheumatoid arthritis. J Hand Surg Am 2005; 30:1282-7. [PMID: 16344189 DOI: 10.1016/j.jhsa.2005.07.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Revised: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE The surgical treatment of the rheumatoid wrist is key in managing the affected hand. Wrist fusion is often the treatment of choice in cases of severe destruction and deformation although most patients would prefer a motion-preserving procedure. The implantation of a wrist prosthesis might be an alternative to partial arthrodesis for selected cases. In this series we analyzed the long-term results (minimum follow-up period, 10 y) of the Swanson silicone spacer for the wrist in patients with rheumatoid arthritis. METHODS Sixteen patients with rheumatoid arthritis with 18 silicone spacers for the wrists were reviewed after a minimum follow-up period of 10 years (average, 15 y). Subjective evaluation, clinical examination, and radiographic analysis were included. An additional 9 patients (9 wrists) were interviewed by telephone. RESULTS In 12 of the patients the subjective result was good or very good, mostly because of adequate pain relief. The average range of motion for flexion (average, 28 degrees )/extension (average, 15 degrees ) was 43 degrees with a wide variation within the series. Radiologically all wrists had diminished residual carpal height at follow-up evaluation and 9 of the wrists had evidence of osteolysis and foreign-body granuloma. The initial good correction of the ulnar translation of the wrist was lost partially in the follow-up period (1.1 vs 4.0 mm). Three of the patients needed surgical revision within the follow-up period; all were converted to wrist fusion. CONCLUSIONS These long-term results suggest that the silicone wrist spacer still may be considered as an alternative to wrist fusion or more complex wrist joint prostheses in patients with rheumatoid arthritis, especially in severe cases and in patients with low demands. In the long term osteolysis caused by foreign-body granulation is to be expected and has to be considered.
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Affiliation(s)
- Urs Kistler
- Department of Hand Surgery, Schulthess Clinic, Zurich, Switzerland
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Angst F, Goldhahn J, John M, Herren DB, Simmen BR. Vergleich des rheumatischen und posttraumatischen Ellenbogengelenks nach Totalprothese. Orthopäde 2005; 34:794, 796-800. [PMID: 15856166 DOI: 10.1007/s00132-005-0786-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with elbow destruction due to rheumatoid arthritis (RA) or trauma (PT) were compared to population-based normative data and to each other after total elbow arthroplasty. PATIENTS AND METHODS Pain, function, and biopsychosocial health were multidimensionally assessed by the generic Short Form 36 (SF-36), the condition-specific Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the Patient Related Elbow Evaluation form (PREE) instrument and analyzed by uni- and multivariate methods. RESULTS Compared to normative values, the examined 59 RA patients were significantly affected in the function scales of the SF-36 and in all DASH scales. The 20 PT patients were worse than the norm only in the DASH function. Function was lower in RA than in PT in the SF-36 scales and in the DASH (RA: 44.4, PT: 70.3, p<0.001). This difference was less distinct in the PREE. CONCLUSION Total elbow arthroplasty led to a pain-free outcome and normal quality of life, but failed to restore complete function. Functional deficits were larger in the RA patients and could also be measured by the SF-36, possibly due to polyarticular affection.
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Affiliation(s)
- F Angst
- Obere Extremitäten- und Handchirurgie, Schulthess-Klinik, Zürich, Schweiz.
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