Patient rated outcomes study into the surgical interventions available for the rheumatoid hand and wrist

• Published in: Archives of orthopaedic and trauma surgery 2016-04, Vol.136 (4), p.563-570
• Main Authors: Riches, Philip L., Elherik, Firas K., Dolan, Sean, Unglaub, Frank, Breusch, Steffen J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthritis, Rheumatoid - surgery; Arthrodesis; Arthroplasty; Decompression, Surgical; Denervation; Female; Finger Joint - surgery; Follow-Up Studies; Hand - surgery; Handsurgery; Humans; Joint surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Pain Measurement; Patient Outcome Assessment; Patient Satisfaction - statistics & numerical data; Patients; Questionnaires; Retrospective Studies; Tenotomy; Wrist Joint - surgery
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-016-2412-1

Introduction A multitude of surgical interventions are recognised for the treatment of the rheumatoid hand and wrist, however there seems to be a distinct lack of patient rated outcome measures (PROMs) studies reporting on the efficacy of these procedures. The aim of this study was to assess the PROMs related to hand and wrist surgery in patients with rheumatoid arthritis (RA). Materials and methods A single surgeon series identified 94 patients (133 hands) with RA who had undergone one of eight surgical procedures (Swanson’s arthroplasty, finger joint or wrist arthrodesis, carpal tunnel decompression, posterior interosseous nerve denervation, RA nodule excision, synovectomy/tenosynovectomy and tendon repair/release) with a mean follow-up period of 3 years. The primary outcome measures were the same for all patients and comprised the validated modified score for the assessment and quantification of chronic rheumatoid affections of the hand (M-SACRAH) and a separate satisfaction questionnaire. Results Highly significant improvements in both function and pain scores are reported across the cohort as a whole following hand surgery, with this pattern replicated within all of the operative subgroups. In keeping with these favourable results very high levels of overall satisfaction were reported with 93 % of patients reporting themselves to be very or fairly satisfied with their procedure. Conclusions Overall, patient reported outcomes in functional, stiffness and pain domains of the M-SACRAH questionnaire appear very favourable across the range of surgical procedures that can be performed in the rheumatoid hand. We believe this data supports the use of all the procedures explored, and will be helpful in patient guidance.