Purpose
There is ongoing discussion about the level of symptoms patients with proximal interphalangeal
(PIP) joint osteoarthritis should have to undergo surgery. The aims of our study were
to determine the minimal important change (MIC) and patient acceptable symptom state
(PASS) for PIP joint range of motion (ROM), and define clinically relevant thresholds
of preoperative pain and function at which patients have the greatest chance to achieve
a MIC and PASS in these outcomes 1 year after PIP arthroplasty.
Methods
We analyzed registry data that included patients with PIP joint osteoarthritis who
underwent an arthroplasty for this condition and had a 1-year follow-up. Patients
indicated pain on a numeric rating scale (0–10) and completed the brief Michigan Hand
Outcomes Questionnaire (MHQ). Active total PIP ROM was measured. The preoperative
thresholds, predictive of achieving the MIC and PASS for each outcome measure of pain,
function, and ROM, were determined using receiver operating characteristics curves.
Results
We included 196 patients who experienced a relevant improvement in ROM (= MIC) when
there was an increase by ≥8° compared with the ROM preoperatively. Patients were satisfied
with their postoperative ROM (= PASS) if they achieved PIP mobility of at least 66°.
Pain at rest and during activities was predictive for achieving a MIC but not a PASS.
Due to an insufficient area under the curve for the brief MHQ and ROM, their baseline
values cannot predict the postoperative achievement of MIC or PASS. We suggest that
patients with preoperative pain at rest ≥4.5 or pain during activities ≥5.5 have the
greatest chance of achieving a subjectively relevant change 1 year after surgery.
Conclusions
The determined thresholds may support surgeons in the preoperative process of deciding
for or against a surgical intervention and explain the probability of achieving sufficient
postoperative symptom relief for the patient.
Level of Evidence
Prognostic I
Key words
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Article Info
Publication History
Published online: October 04, 2022
Accepted:
July 29,
2022
Received:
July 7,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. S. Schindele and D.B. Herren receive royalties from KLS Martin Group, Tuttlingen, Germany.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
