Evidence-Based Practice in the Surgical Treatment of Thumb Carpometacarpal Joint Arthritis

Abstract

Purpose: Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure.

Methods: Using a random 5%, nationally representative, sample of Medicare fee-for-service beneficiaries diagnosed with thumb CMC arthritis between 2001 and 2010, we used a multinomial logistic regression model to assess the association between patients' characteristics and the surgical treatment. Furthermore, we used surgeons' unique identifiers to examine how their practice preferences have changed over time.

Results: Our findings demonstrated an increasing trend in the utilization of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) from 84% in 2001 to 90% in 2010. Ninety-five percent of surgeons performed only 1 type of surgical procedure, and among those, 93% of surgeons performed only trapeziectomy with LRTI. Compared with 2001, the odds of a patient undergoing thumb CMC arthrodesis or prosthetic arthroplasty slightly increased between 2007 and 2010.

Conclusions: The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. Although clinical trials from the United Kingdom support the use of the less complex trapeziectomy-only procedure, US surgeons are still reticent to change their practice, which favors LRTI. National comparative studies are still needed to examine the effectiveness of various surgical options for the treatment of thumb CMC joint arthritis.

Type of study/level of evidence: Prognostic II.

Keywords: Evidence-based; osteoarthritis; thumb carpometacarpal; trends; utilization.

Figure 1

Flow chart for defining our study cohort using 2001–2010 Medicare claims data

Figure 2

Percentage of surgeons performing each of the four types of surgical treatments for thumb carpometacarpal (CMC) arthritis (Source: The 2001–2010 Medicare claims data)

Figure 3

a: Percentage of surgeons performing one, two, or three procedure types per year (Source: The 2001–2010 Medicare claims data) b: Percentage of surgeons performing only one procedure type - either (1) partial/complete trapeziectomy with ligament reconstruction and tendon interposition, (2) simple complete trapeziectomy, (3) thumb carpometacarpal arthrodesis, or (4) thumb carpometacarpal prosthetic arthroplasty per year (Source: The 2001–2010 Medicare claims data)

Figure 3

a: Percentage of surgeons performing one, two, or three procedure types per year (Source: The 2001–2010 Medicare claims data) b: Percentage of surgeons performing only one procedure type - either (1) partial/complete trapeziectomy with ligament reconstruction and tendon interposition, (2) simple complete trapeziectomy, (3) thumb carpometacarpal arthrodesis, or (4) thumb carpometacarpal prosthetic arthroplasty per year (Source: The 2001–2010 Medicare claims data)