Osteoarthritis of the first carpometacarpal joint - Patients' subjective symptoms related to surgical outcome

Abstract

Objectives: Osteoarthritis (OA) of the first carpometacarpal joint (CMC 1) is common and prevalence increases with age. Pain and disability impair daily life activities. The aim was 1) to evaluate outcome, with special interest in patient-rated functional outcome measures with the Quick Disability of Arm, Shoulder and Hand questionnaire (QuickDASH) after primary surgical treatment with ligament reconstruction and tendon interposition (LRTI) due to OA and 2) to clarify remaining postoperative symptoms, adverse effects and costs for treatment. Methods: In the retrospective study, 54 patients (55 primary surgeries; response rate 33/54 patients, 61%; 33/55 surgeries, (60%) were reviewed with QuickDASH preoperatively and after one year. Data were also obtained from the patients' declaration of health and patient folders. Results: Surgery resulted in reduced QuickDASH score [from 52 (42-72) to 34 (13-51), p=0.0001]. Twenty-eight (85%) surgeries out of 33 were dismissed from outpatient care at a final follow-up visit within one year [median rehabilitation period 111 (67-179) days]. Nineteen (68%) out of these 28 patients still suffered from symptoms or adverse effects at the last visit, mostly related to pain. No differences were found between smokers and non-smokers. The five patients, not concluded within one year, required further conservative treatment and/or surgical procedures due to various symptoms. Total median costs for treatment were US$ 3436 (3147-3949) [€ 2593 (2374-2979)]. Conclusions: Patients with OA of the CMC 1 joint benefit from surgery, but the procedure is associated with lengthy rehabilitation and persisting postoperative symptoms; meticulous preoperative information should be provided to patients.