This is a prospective study tracking the outcomes of patients who undergo either of two treatments for thumb carpo-metacarpal joint arthritis: trapeziectomy with ligament reconstruction (LRTI) or denervation.
A total of 100 patients with carpo-metacarpal (CMC) arthritis will be enrolled in the study. The design of the study is a prospective non-blinded, non-randomized control study. Enrollment will occur at the time of initial clinic visit. All patients presenting with CMC arthritis and deemed appropriate for surgery will be considered for screened for inclusion. As a part of routine workup for CMC arthritis patients receive a hand xray. Specific attendings will perform their preferred technique for CMC arthritis: two perform denervation of the CMC joint, and two perform trapeziectomy with ligament reconstruction tendon-interposition (LRTI) only per their normal clinical practice. Pre-operative and peri-operative care will be unchanged from standard patient care. Both procedures are outpatient procedures, usually performed under regional anesthesia and patients go home the same day. Patients are discharged with a standard thumb spica splint which is removed on their first clinic appointment which is generally post-operative day 7. Patients enrolled in the study will have additional follow up at the 3, 6, 12 and 24 month time points. At the 3, 6, 12 and 24 month time points patients will be asked to come to clinic for evaluation with 1) a standard hand questionnaire the Michigan Hand Questionnaire, 2) lateral pinch strength, grip strength and range of motion testing, 3) Kapandji score, 4) visual analog pain scale. Each visit will take approximately 15 minutes. Patients who are unable to follow up in clinic will be given a phone questionnaire with the Michigan Hand Questionnaire, visual analog pain scale and opiate usage. There is no monetary compensation for participation in the study.
Study Type
OBSERVATIONAL
Enrollment
53
Removal/disconnection of the nerve branches to the joint from their attachments to the joint
excision of the trapezium and suspension of the thumb metacarpal with the flexor carpi radialis tendon
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States
Change in Hand Function
brief Michigan Hand Questionnaire (MHQ). (score ranges from 0 to 100, lower score indicates better function)
Time frame: Through study completion at 2 years. Measurements will be performed prior to surgery, at 3 months, 6, months, 12 months, and 2 years.
Change in grip and lateral pinch strength
position 2 on dynamometer (grip) and pinch meter (both are measured in kg of force, higher value indicates more strength)
Time frame: Through study completion at 2 years. Measurements will be performed prior to surgery, at 3 months, 6 months, 12 months, and 2 years.
Change in pain level
Likert scale (score ranges from 0-10, lower score indicates less pain)
Time frame: Through study completion at 2 years. Measurements will be performed prior to surgery, at 3 months, 6 months, 12 months, and 2 years.
narcotic pain medication usage
number of oxycodone 5 mg tablets (or equivalent) used after surgery (lower value indicates fewer narcotic tablets used)
Time frame: Up to 3 months.
Time to release to unrestricted activity
Number of days between surgery day and when patient is released to unrestricted activity (lower value indicates fewer days between day of surgery and when the patient was released to unrestricted activity).
Time frame: Up to 6 months.
Operative duration
Tourniquet time and surgery start to surgery end time (both measured in minutes, lower values indicate the surgery took less time to complete)
Time frame: Up to 1 day
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