Purpose
Corticosteroid injections are commonly used to treat thumb carpometacarpal arthritis
in adults. We aimed to define the timing of surgery following an initial corticosteroid
injection and identify patient-specific factors that influence the likelihood of repeat
injection or surgery.
Methods
We performed a retrospective analysis of all patients who underwent a first-time corticosteroid
injection for carpometacarpal arthritis between 2009 and 2017. Demographic information,
radiographic classification, additional nonsurgical therapies, complications, and
outcomes were collected. Primary outcomes were repeat injection and surgical reconstruction.
Kaplan-Meier survival analysis was used to characterize the timing of surgical intervention
and Cox regression modeling was used to identify predictors of subsequent intervention.
Results
Two-hundred thirty-nine patients (average age, 62.9 years) were identified, of which
141 (59.0%) had a repeat injection and 90 (37.6%) underwent surgery. There were no
patient-specific characteristics associated with repeat injection. Eaton stage III/IV
arthritis at initial presentation, current smoking status, and prior ipsilateral hand
surgery were associated with an increased likelihood of surgery. By Kaplan-Meier analyses,
87.7% of patients who presented with Eaton III/IV arthritis did not have surgery within
a year and 66.7% of these patients did not have surgery within 5 years.
Conclusions
In this retrospective observational cohort study with 10-year follow-up from a 4-surgeon
practice, advanced radiographic arthritis, current smoking status, and a history of
ipsilateral hand surgery were patient-specific factors that predicted progression
to surgery following injection. Of patients who presented with advanced radiographic
arthritis, one-third underwent surgery within 5 years of initial injection. Although
injection efficacy and causality cannot be inferred based on an observational longitudinal
analysis, these data identify patient-specific factors that may have an impact on
surgical decision-making and a potential timeframe for future intervention.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: May 22, 2020
Accepted:
March 27,
2020
Received:
June 8,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
