The objective was to examine outcomes associated with a large cohort of revision metacarpophalangeal (MCP) arthroplasties.A review of 128 revision MCP arthroplasties performed in 64 patients was performed. The mean age at surgery was 62 years. Fifty nonconstrained (31 pyrocarbon and 19 surface-replacing arthroplasty) and 78 constrained silicone implants were used for revisions.At a follow-up of 6 years (2 to 16), 20 (16%) implants required a secondary revision surgery. The 5- and 10-year survival rates were 81% and 79%, respectively. Postoperative dislocation occurred in 17 (13%) MCP joints. Subgroup analysis demonstrated a 5-year survival rate of 67% in surface-replacing arthroplasties, compared with 83% for both pyrocarbon and silicone implants (hazard ratio, 2.60; P = 0.09). Clinical improvements in pain and MCP range of motion were noted in most patients postoperatively.Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. However, most patients who did not undergo a secondary revision surgery experienced improvements in pain and range of motion. Worse outcomes are seen in patients with a history of MCP dislocations.Level IV.
As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of 'decisional conflict' of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9).On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons. Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one's goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
