Non-surgical treatment shows positive results for patients with carpometacarpal osteoarthritis.

In a groundbreaking study, researchers have provided valuable insights into the long-term effectiveness of nonsurgical treatments for thumb carpometacarpal (CMC-1) osteoarthritis (OA). They found that nonsurgical treatments are effective in managing CMC-1 OA beyond the 12-month mark, offering patients enduring relief, improved quality of life, and reducing the need for surgery. The study results were published in the Journal of Bone & Joint Surgery. 

While nonsurgical interventions for thumb carpometacarpal (CMC-1) osteoarthritis (OA) offer short-term relief, the long-term sustainability of these benefits beyond a year remains uncertain. Hence researchers from the Netherlands conducted a study to explore patient-reported experiences of pain and constraints in daily activities over a period exceeding 5 years after nonsurgical treatments, specifically exercise therapy and orthotic use, for CMC-1 OA. They based the study on the hypothesis that pain and limitations in daily activities would not deteriorate after the initial 12 months. Secondary objectives encompassed assessing patient satisfaction with treatment outcomes, gauging health-related quality of life after more than 5 years of follow-up, and evaluating the rate of conversion to surgical intervention.

The study was a prospective cohort investigation conducted across multiple medical centers, employing two distinct, partially overlapping sets of participants. The primary focus was to measure changes in the subscales of pain and activities of daily living (ADL) using the Michigan Hand Outcomes Questionnaire (MHQ) between the 12-month mark and beyond 5 years. The initial sample (n = 170) comprised patients who did not undergo surgery, and the assessment included additional data points at baseline and 3 months. A second sample (n = 217) was analyzed to assess the rate of conversion to surgical intervention, which included all patients who responded to the invitation for this follow-up study.

Findings: 

• The study found that, at a median follow-up of 6.6 years (ranging from 5.1 to 8.7 years), patients did not show a significant change in the MHQ pain subscale. 
• Additionally, while limitations in ADL did show some improvement beyond the one-year mark, the degree of improvement was not considered clinically relevant. 
• Patient Satisfaction and Quality of Life
• In this study, more than five years after the initial treatment, the majority of patients reported good (39%) to excellent (16%) satisfaction with their outcomes while the remaining rated as fair (26%), moderate (14%) and poor (5%). 
• Quality of life was assessed using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score, with patients scoring a median index of 0.852, indicating a reasonable quality of life. 
• Reduced Need for Surgery
• One of the most remarkable findings was the reduced rate of conversion to surgery. At a median follow-up of seven years, only 22% of patients required surgical intervention. 

Thus the results of this study have important implications for the field of orthopedics and patient care. It provides strong support for the use of nonsurgical treatments as the first-line approach for managing CMC-1 OA. Patients and healthcare professionals can now have greater confidence that these treatments can offer lasting relief from pain and functional improvement. The study's findings underscore the sustainability of the treatment effects and advocate for a conservative, nonsurgical approach to managing CMC-1 OA, helping patients avoid or delay surgical intervention. It encourages patients and healthcare providers to consider nonsurgical options as the primary choice for treating CMC-1 OA, bringing hope and comfort to those dealing with this condition. 

Further reading: Esteban Lopez, Lisa M.J. MSc, PT1,2,3,a; Hoogendam, Lisa MSc1,2,4; Vermeulen, Guus M. MD, PhD4; Tsehaie, Jonathan PhD1,2,5; Slijper, Harm P. PhD1; Selles, Ruud W. PhD1,2; Wouters, Robbert M. PhD, PT1,2; The Hand-Wrist Study Group*. Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study. The Journal of Bone and Joint Surgery ():10.2106/JBJS.22.01116, October 30, 2023. | DOI: 10.2106/JBJS.22.01116