University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
Health Qual Life Outcomes. 2020 Mar 30;18(1):90. doi: 10.1186/s12955-020-01333-z.
Trapeziometacarpal (TMC) osteoarthritis can be painful and cause disability for patients. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint.
We included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the TMC joint due to osteoarthritis with a mean age of 58.9 years (range 41-80) in a prospective cohort study. We collected information preoperatively and 12 months postoperatively on disabilities of the arm, shoulder and hand score (DASH), grip strength and pain at rest and activity on a visual analogue scale (VAS).
We found a statistically significant improvement in DASH from 42.0 to 15.9 (p < 0.001), VAS at rest from 3.5 to 0.6 (p < 0.001), VAS at activity from 7.9 to 2.5 (p < 0.001) and grip strength from 21.6 kg to 27.6 kg (p < 0.001) 12 months after the operation, when analysed as a group. There was an increased risk of no clinically important improvement in hand function for patients with preoperative high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients when using VAS as outcome.
However, we were unable to detect one isolated preoperative predictor as indicator of successful result after operative treatment of TMC osteoarthritis, and as so it was not possible to establish a clinical valid tool for patient selection before surgery. Informed consent was obtained from all patients for being included in the study. The study needed no approval from The Regional Committee of Biomedical Research Ethics as the data was collected, as part of our normal pre- and postoperative clinical pathway, but the study is part of an outcome study of the results after total joint arthroplasty (TJA) of the TMC joint registered in Clinicaltrials.gov (NCT01554748).
Clinicaltrials.gov (NCT01554748). Registered 15 March 2012.
掌指关节（TMC）骨关节炎可引起患者疼痛和残疾。TMC 关节的全关节置换可提供假性关节融合，并在大多数患者中恢复拇指运动和缓解疼痛。但术后也存在无改善的风险。本研究旨在确定 TMC 关节骨关节炎手术治疗后无临床重要改善的风险患者。
我们纳入了 287 例连续患者（225 名女性，62 名男性），因骨关节炎接受 TMC 关节全关节置换术，平均年龄 58.9 岁（范围 41-80 岁），前瞻性队列研究。我们在术前和术后 12 个月收集了残疾的手臂、肩膀和手评分（DASH）、握力和静息和活动时的疼痛的视觉模拟量表（VAS）信息。
我们发现 DASH 从 42.0 分降至 15.9 分（p<0.001）、静息时 VAS 从 3.5 分降至 0.6 分（p<0.001）、活动时 VAS 从 7.9 分降至 2.5 分（p<0.001）和握力从 21.6kg 增加至 27.6kg（p<0.001），当作为一个组进行分析时，术后 12 个月。术前高握力的患者手部功能无临床显著改善的风险增加。此外，我们发现女性患者使用 VAS 作为结局时，无临床显著改善的风险增加。
然而，我们无法检测到一个孤立的术前预测指标作为 TMC 骨关节炎手术治疗后成功结果的指标，因此无法在手术前为患者选择建立一种临床有效的工具。所有患者均签署知情同意书，同意参与研究。该研究不需要区域生物医学研究伦理委员会的批准，因为该研究的数据是作为我们正常的术前和术后临床路径的一部分收集的，但该研究是在 Clinicaltrials.gov（NCT01554748）注册的 TMC 关节全关节置换术后结果的一项结局研究的一部分。
Clinicaltrials.gov（NCT01554748）。2012 年 3 月 15 日注册。
