Abstract
ObjectivesIntra-articular steroid injection is commonly used to treat base of thumb osteoarthritis (BTOA), despite a lack of large-scale data on safety and effectiveness. We estimate the incidence of serious complications and further procedures following BTOA injection, including the risk of post-operative serious surgical site infection for subsequent operative intervention.MethodsHospital Episode Statistics data linked to mortality records from 1 April 1998 to 31 March 2017 were used to identify all BTOA injections undertaken in adults in the National Health Service secondary care in England. Patients were followed up longitudinally until death or 31 March 2017. A multivariable regression with a Fine and Gray model adjusting for the competing risk of mortality in addition to age, sex and socioeconomic deprivation was used to identify factors associated with progression to further procedure. Secondary outcomes included serious complications after injection and subsequent surgical site infection.ResultsA total of 19 120 primary injections were performed during the 19-year period in 18 356 patients. Of these 76.5% were female; mean age 62 years (s.d. 10.6); 50.48% underwent further procedure; 22.40% underwent surgery. Median time to further intervention was 412 days (IQR 110–1945). Female sex was associated with increased risk of proceeding to surgery. Serious complication rate following injection was 0.04% (0.01–0.08) within 90 days. Of those proceeding to surgery 0.16% (0.06–0.34) presented with a wound infection within 30 days and 90 days, compared with an overall post-operative wound infection rate of 0.03% (0.02–0.05).ConclusionsVery low rates of serious complications were identified following BTOA injections performed in secondary care; only one in five patients proceeded to subsequent surgery.Clinical trial registrationclinicaltrials.gov, https://www.clinicaltrials.gov, NCT03573765
Highlights
Base of thumb osteoarthritis (BTOA) is a common hand condition presenting to primary and secondary care physicians, characterized by pain and reduced function [1,2,3]
Secondary aims were to identify factors associated with proceeding to further intervention, especially surgery, serious complications and whether having a BTOA injection prior to surgery affected the risk of serious surgical site infection
A total of 83% of patients identified themselves as being of a white background, and the socio-demographic distribution of patients undergoing primary BTOA injection was roughly even across the strata
Summary
Base of thumb osteoarthritis (BTOA) is a common hand condition presenting to primary and secondary care physicians, characterized by pain and reduced function [1,2,3]. Treatment options for BTOA include intraarticular steroid injection in addition to splinting and hand therapy [4, 5]. Developing best evidence for hand arthritis is a research priority for patients with hand conditions in the UK [6]. Systematic reviews of available randomized control trials and case series noted that evidence of efficacy of intra-articular steroid injections for BTOA was limited and heterogeneous [7,8,9,10]. Smaller single-centre studies have estimated that following BTOA intra-articular steroid injection, only around one-third proceed to surgery [11]. Research from a recent large US insurance dataset raised concerns that BTOA steroid injections predispose patients to a higher risk of postoperative complications [12]. Previous studies in other areas of the body have found no evidence to support this finding [13, 14]
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