Advertisement

Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis

Published:December 19, 2019DOI:https://doi.org/10.1016/j.jhsa.2019.10.017

      Purpose

      Operative treatment of trapeziometacarpal osteoarthritis (TMC OA) is discretionary. There is substantial surgeon-to-surgeon variation in offers of surgery. This study assessed factors associated with variation in recommendation of operative treatment to patients with TMC OA. Secondarily, we studied factors associated with preferred operative technique and surgeon demographic factors variability in recommendation for operative treatment.

      Methods

      We invited all hand surgeon members of the Science of Variation Group to review 16 scenarios of patients with TMC OA and asked the surgeons whether they would recommend surgical treatment for each patient and, if yes, which surgical technique they would offer (trapeziectomy, trapeziectomy with ligament reconstruction and/or tendon interposition, joint replacement, or arthrodesis). Scenarios varied in pain intensity, relief after injection, radiographic severity, and psychosocial symptoms.

      Results

      Patient characteristics associated with greater likelihood to recommend surgical treatment were substantial pain, a previous injection that did not relieve pain, radiograph with severe TMC OA, and few symptoms of depression. Practice region was the only factor associated with preferred surgical technique and trapeziectomy with ligament reconstruction and/or tendon interposition the most commonly recommended treatment. There was low agreement among surgeons regarding treatment recommendations.

      Conclusions

      The notable variation in offers of operative treatment for TMC OA is largely associated with variable attention to subjective factors. Future studies might address the relative influence of surgeon incentives and beliefs, objective pathophysiology, and subjective patient factors on variation in surgeon recommendations.

      Clinical relevance

      Surgeons’ awareness of the potential influence of subjective factors on their recommendations might contribute to efforts to ensure that patient choices reflect what matters most to them and are not based on misconceptions.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Becker S.J.E.
        • Briet J.P.
        • Hageman M.G.
        • Ring D.
        Death, taxes, and trapeziometacarpal arthrosis hand.
        Clin Orthop Relat Res. 2013; 471: 3738-3744
        • Hwang R.W.
        • Ring D.
        Pain and disability related to osteoarthrosis of the trapeziometacarpal joint.
        J Hand Microsurg. 2011; 3: 63-65
        • Becker S.J.E.
        • Makarawung D.J.S.
        • Spit S.A.
        • King J.D.
        • Ring D.
        Disability in patients with trapeziometacarpal joint arthrosis: incidental versus presenting diagnosis.
        J Hand Surg Am. 2014; 39: 2009-2015
        • Edwards K.A.
        • Pielech M.
        • Hickman J.
        • Ashworth J.
        • Sowden G.
        • Vowles K.E.
        The relation of self-compassion to functioning among adults with chronic pain.
        Eur J Pain. 2019; 23: 1538-1547
      1. Ferreira-Valente A, Damião C, Pais-Ribeiro J, Jensen MP. The role of spirituality in pain, function, and coping in individuals with chronic pain [published online ahead of print May 2, 2019]. Pain Med. https://doi.org/10.1093/pm/pnz092.

        • De Baets L.
        • Matheve T.
        • Meeus M.
        • Struyf F.
        • Timmermans A.
        The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review.
        Clin Rehabil. 2019; 33: 980-991
        • Jensen M.P.
        • Turner J.A.
        • Romano J.M.
        Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment.
        J Consult Clin Psychol. 2001; 69: 655-662
        • Jensen M.P.
        • Turner J.A.
        • Romano J.M.
        Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning.
        Pain. 2007; 131: 38-47
        • Sullivan M.J.L.
        • Lynch M.E.
        • Clark A.J.
        Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions.
        Pain. 2005; 113: 310-315
        • Edwards R.R.
        • Fillingim R.B.
        • Maixner W.
        • Sigurdsson A.
        • Haythornthwaite J.
        Catastrophizing predicts changes in thermal pain responses after resolution of acute dental pain.
        J Pain. 2004; 5: 164-170
        • Tsehaie J.
        • Porsius J.T.
        • Rizopoulos D.
        • et al.
        Response to conservative treatment for thumb carpometacarpal osteoarthritis is associated with conversion to surgery: a prospective cohort study.
        Phys Ther. 2019; 99: 570-576
        • Sodha S.
        Prevalence of osteoarthrosis of the trapeziometacarpal joint.
        J Bone Joint Surg. 2005; 87: 2614
        • Wilkens S.C.
        • Meghpara M.M.
        • Ring D.
        • Coert J.H.
        • Jupiter J.B.
        • Chen N.C.
        Trapeziometacarpal arthrosis.
        JBJS Rev. 2019; 7: e8
        • Becker S.J.E.
        • Teunis T.
        • Blauth J.
        • Kortlever J.T.P.
        • Dyer G.S.M.
        • Ring D.
        Medical services and associated costs vary widely among surgeons treating patients with hand osteoarthritis.
        Clin Orthop Relat Res. 2014; 473: 1111-1117
        • Spaans A.J.
        • van Laarhoven C.M.
        • Schuurman A.H.
        • van Minnen L.P.
        Interobserver agreement of the Eaton-Littler classification system and treatment strategy of thumb carpometacarpal joint osteoarthritis.
        J Hand Surg Am. 2011; 36: 1467-1470
        • Deutch Z.
        • Niedermeier S.R.
        • Awan H.M.
        Surgeon preference, influence, and treatment of thumb carpometacarpal arthritis.
        Hand (N Y). 2018; 13: 403-411
        • Ochtman A.E.A.
        • Guitton T.G.
        • Buijze G.A.
        • et al.
        Trapeziometacarpal arthrosis: predictors of a second visit and surgery.
        J Hand Microsurg. 2013; 5: 9-13
        • Wolf J.M.
        • Delaronde S.
        Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons.
        J Hand Surg Am. 2012; 37: 77-82
        • Yuan F.
        • Aliu O.
        • Chung K.C.
        • Mahmoudi E.
        Evidence-based practice in the surgical treatment of thumb carpometacarpal joint arthritis.
        J Hand Surg Am. 2017; 42: 104-112.e1
        • Wajon A.
        • Vinycomb T.
        • Carr E.
        • Edmunds I.
        • Ada L.
        Surgery for thumb (trapeziometacarpal joint) osteoarthritis.
        Cochrane Database Syst Rev. 2015; 2: CD004631
        • Teunis T.
        • Janssen S.J.
        • Guitton T.G.
        • Vranceanu A.M.
        • Goos B.
        • Ring D.
        Surgeon personality is associated with recommendation for operative treatment.
        Hand (N Y). 2015; 10: 779-784
        • Birkmeyer J.D.
        • Reames B.N.
        • McCulloch P.
        • Carr A.J.
        • Campbell W.B.
        • Wennberg J.E.
        Understanding of regional variation in the use of surgery.
        Lancet. 2013; 382: 1121-1129
        • Bruinsma W.E.
        • Guitton T.G.
        • Warner J.J.P.
        • Ring D.
        • Science of Variation Group
        Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT.
        J Bone Joint Surg Am. 2013; 95: 1600-1604
        • Lee J.
        • Fung K.P.
        Confidence interval of the kappa coefficient by bootstrap resampling.
        Psychiatry Res. 1993; 49: 97-98
        • Viera A.J.
        • Garrett J.M.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Becker S.J.
        • Bot A.G.
        • Curley S.E.
        • Jupiter J.B.
        • Ring D.
        A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis.
        Osteoarthritis Cartilage. 2013; 21: 668-675
        • Lozano-Calderon S.A.
        • Souer J.S.
        • Jupiter J.B.
        • Ring D.
        Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis.
        Hand (N Y). 2008; 3: 271-275
        • Makarawung D.J.S.
        • Becker S.J.E.
        • Bekkers S.
        • Ring D.
        Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome.
        Hand (N Y). 2013; 8: 375-381
        • Zhang Y.
        • Niu J.
        • Kelly-Hayes M.
        • Chaisson C.E.
        • Aliabadi P.
        • Felson D.T.
        Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study.
        Am J Epidemiol. 2002; 156: 1021-1027
        • Wilkens S.C.
        • Menendez M.E.
        • Ring D.
        • Chen N.
        QuickDASH score is associated with treatment choice in patients with trapeziometacarpal.
        Hand (N Y). 2017; 12: 461-466
        • Habib G.S.
        • Saliba W.
        • Nashashibi M.
        Local effects of intra-articular corticosteroids.
        Clin Rheumatol. 2010; 29: 347-356
        • Meenagh G.K.
        • Patton J.
        • Kynes C.
        • Wright G.D.
        A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis.
        Ann Rheum Dis. 2004; 63: 1260-1263
        • Stahl S.
        • Karsh-Zafrir I.
        • Ratzon N.
        • Rosenberg N.
        Comparison of intra-articular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints.
        J Clin Rheumatol. 2005; 11: 299-302
        • Wolf J.M.
        Injections for trapeziometacarpal osteoarthrosis.
        J Hand Surg Am. 2010; 35: 1007-1009
        • Fujita T.
        • Fukuyama R.
        • Enomoto H.
        • Komori T.
        Dexamethasone inhibits insulin-induced chondrogenesis of ATDC5 cells by preventing PI3K-Akt signaling and DNA binding of Runx2.
        J Cell Biochem. 2004; 93: 374-383
        • McAlindon T.E.
        • LaValley M.P.
        • Harvey W.F.
        • et al.
        Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis a randomized clinical trial.
        JAMA. 2017; 317: 1967-1975
        • Linton S.J.
        • Andersson T.
        Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain.
        Spine (Phila Pa 1976). 2000; 25: 2825-2831
        • Vranceanu A.-M.
        • Barsky A.
        • Ring D.
        Psychosocial Aspects of disabling musculoskeletal pain.
        J Bone Joint Surgery Am. 2009; 91: 2014-2018
        • van Tulder M.W.
        • Koes B.
        • Malmivaara A.
        Outcome of non-invasive treatment modalities on back pain: an evidence-based review.
        Eur Spine J. 2006; 15: S64-S81
        • Feuerstein M.
        • Burrell L.M.
        • Miller V.I.
        • Lincoln A.
        • Huang G.D.
        • Berger R.
        Clinical management of carpal tunnel syndrome: a 12-year review of outcomes.
        Am J Ind Med. 1999; 35: 232-245
        • Fordyce W.E.
        • Brockway J.A.
        • Bergman J.A.
        • Spengler D.
        Acute back pain: a control-group comparison of behavioral vs traditional management methods.
        J Behav Med. 1986; 9: 127-140
        • Vranceanu A.M.
        • Hageman M.
        • Strooker J.
        • Ter Meulen D.
        • Vrahas M.
        • Ring D.
        A preliminary RCT of a mind body skills based intervention addressing mood and coping strategies in patients with acute orthopaedic trauma.
        Injury. 2015; 46: 552-557
        • Zale E.L.
        • Ring D.
        • Vranceanu A.M.
        The future of orthopaedic care: promoting psychosocial resiliency in orthopaedic surgical practices.
        J Bone Joint Surg Am. 2018; 100: e89
        • Vranceanu A.M.
        • Beks R.B.
        • Guitton T.G.
        • Janssen S.J.
        • Ring D.
        How do orthopaedic surgeons address psychological aspects of illness?.
        Arch Bone Joint Surg. 2017; 5: 2-9
        • Wajon A.
        • Carr E.
        • Edmunds I.
        • et al.
        Surgery for thumb (trapeziometacarpal joint) osteoarthritis (short summary).
        Cochrane Database Syst Rev. 2015; 2: CD004631
        • Vermeulen G.M.
        • Slijper H.
        • Feitz R.
        • Hovius S.E.R.
        • Moojen T.M.
        • Selles R.W.
        Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.
        J Hand Surg Am. 2011; 36: 157-169
        • Janssen S.J.
        • Molleman J.
        • Guitton T.G.
        • Ring D.
        • Science of Varisation Group
        What middle phalanx base fracture characteristics are most reliable and useful for surgical decision-making?.
        Clin Orthop Relat Res. 2015; 473: 3943-3950
        • Janssen S.J.
        • Teunis T.
        • Guitton T.G.
        • Ring D.
        Do surgeons treat their patients like they would treat themselves?.
        Clin Orthop Relat Res. 2015; 473: 3564-3572
        • Hageman M.G.
        • Guitton T.G.
        • Ring D.
        • et al.
        How surgeons make decisions when the evidence is inconclusive.
        J Hand Surg Am. 2013; 38: 1202-1208
        • Col N.F.
        • Solomon A.J.
        • Springmann V.
        • et al.
        Whose preferences matter? A patient-centered approach for eliciting treatment goals.
        Med Decis Making. 2018; 38: 44-55
        • Wilkens S.C.
        • Ring D.
        • Teunis T.
        • Lee S.P.
        • Chen N.C.
        Decision aid for trapeziometacarpal arthritis: a randomized controlled trial.
        J Hand Surg Am. 2019; 44: 247.e1-247.e9