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Multicenter Study
. 2023 Dec 6;105(23):1837-1845.
doi: 10.2106/JBJS.22.01116. Epub 2023 Oct 30.

Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study

Lisa M J Esteban Lopez  1   2   3 , Lisa Hoogendam  1   2   4 , Guus M Vermeulen  4 , Jonathan Tsehaie  1   2   5 , Harm P Slijper  1 , Ruud W Selles  1   2 , Robbert M Wouters  1   2 ; The Hand-Wrist Study Group
Collaborators, Affiliations
Multicenter Study

Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study

Lisa M J Esteban Lopez et al. J Bone Joint Surg Am. .

Abstract

Background: Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery.

Methods: This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217).

Results: At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years).

Conclusions: We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable.

Level of evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H688 ).

Figures

Fig. 1
Fig. 1
Flowchart for the study. CMC-1 = thumb carpometacarpal joint, OA = osteoarthritis, and MHQ = Michigan Hand Outcomes Questionnaire. Note that sample 1 is a subset of sample 2.
Fig. 2
Fig. 2
Mean scores on the Michigan Hand Outcomes Questionnaire (MHQ) subscales over time. Most improvement was seen in the first 3 months. The error bars show the 95% confidence interval.
Fig. 3
Fig. 3
Patient satisfaction with the treatment result (n = 163), expressed in percentages.
Fig. 4
Fig. 4
Survival curve. The blue line indicates the proportion of patients who did not undergo conversion to surgery and the time, in months, before deciding to convert to surgery. At a median follow-up of 7.0 years, 22% had decided to convert to surgery. The median time to decide to convert to surgery was 7.4 months after treatment initiation. The light blue shading indicates the 95% confidence interval. Censoring means that the patient had not converted to surgery at the time the study was conducted.
See this image and copyright information in PMC

References

    1. Bijlsma JWJ, Berenbaum F, Lafeber FPJG. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011. Jun 18;377(9783):2115-26. - PubMed
    1. Haugen IK, Englund M, Aliabadi P, Niu J, Clancy M, Kvien TK, Felson DT. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis. 2011. Sep;70(9):1581-6. - PMC - PubMed
    1. van der Oest MJW, Duraku LS, Andrinopoulou ER, Wouters RM, Bierma-Zeinstra SMA, Selles RW, Zuidam JM. The prevalence of radiographic thumb base osteoarthritis: a meta-analysis. Osteoarthritis Cartilage. 2021. Jun;29(6):785-792. - PubMed
    1. Centraal Bureau voor de Statistiek. Population; key figures, 1950-2022. 2023. Accessed 2023 Jul 27. https://www.cbs.nl/nl-nl/cijfers/detail/37296ned.
    1. Nederlandse Vereniging voor Handchirurgie. Conservatieve en Chirurgische Behandeling van Primaire Artrose van de Duimbasis. 2014. Accessed 2023 Jul 27. https://www.nvpc.nl/uploads/stand/150416DOC-MB-Definitieve_richtlijn_Con....

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