Article
The management of thumb base osteoarthritis – A multicentre service evaluation project
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Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Thumb base (trapeziometacarpal) osteoarthritis is a common problem, with 15% radiographic prevalence across the entire adult population and as much as 91% of those over the age of 80 years. Resultant pain and loss of function can severely affect quality of life. The British Society of Hand Surgery (BSSH) advises surgery be reserved as a last resort option, for those with symptoms refractory to non-operative treatments. We aimed to assess current UK practice in the management of thumb base OA in secondary care, with specific regard to; the nature and duration of non-operative treatments and the surgical procedures performed.
Methods: 10 consecutive patients undergoing surgery for thumb base OA from 12 UK centres were prospectively identified. Patient demographics, symptom duration, radiographic Eaton-Littler grade, non-operative management strategies and the operation performed were recorded.
Results and Conclusions: Data was gathered for 120 patients from 12 centres over a 12 month period. The mean age was 64 years, comprising of 26 males and 94 females. The mean symptom duration pre-surgery was 32 months, and the median radiological grade was 3.
40% of patients had physiotherapy pre-surgery and 50% used a splint. 80% of patients received at least one injection, with a median of two injections pre-surgery. 100% of injections were a corticosteroid derivative. 74% were image guided (61% fluoroscopic and 13% ultrasound) and 26% were landmark guided. Simple trapeziectomy was carried out in 43% of cases, compared to surgery involving ligament reconstruction and/or interposition arthroplasty in 56%. Two patients had alternative operations, including one arthroplasty and one arthrodesis.
There is considerable variation in practice of both non-operative and operative management of thumb base OA in the UK. It is interesting that image guidance is the most common means of injection delivery. These findings likely relate to a lack of high quality evidence from which to guide practice and demonstrate the need for future research in this area.