Concurrent Management of Carpometacarpal Arthritis and Metacarpophalangeal Hyperextension: A Survey of Fellowship-Trained Hand Surgeons

Abstract

Background:

Carpometacarpal (CMC) osteoarthritis can be associated with metacarpophalangeal (MCP) joint hyperextension. During CMC arthroplasty, surgeons may or may not choose to treat MCP hyperextension. This study aims to elucidate the preferences of surgeons regarding concurrent treatment of MCP hyperextension during CMC arthroplasty and identify factors that influence their decision-making.

Methods:

A survey inquiring about practice and training characteristics, CMC arthroplasty volume and type, concurrent MCP procedure and criteria for intervention, and perceived outcomes was formulated by the authors. It was distributed to orthopedic and plastic surgery fellowship-trained hand surgeons via REDCap.

Results:

Surveys were sent to 478 surgeons, and 73 responded (15.3% response rate). Academia accounted for 60.3% of the respondents, followed by 34.2% in hybrid private/academic practice. Length of practice ranged from <5 years (21.9%) to >30 years (19.2%). Most surgeons (69.0%) performed <30 CMC arthroplasties per year, and the most common procedure of choice was trapezium resection and suspensionplasty (63.9%). 61.6% of respondents reported performing an MCP procedure at the time of CMC arthroplasty. During residency and fellowship, 43.8% and 68.1% were taught to perform the technique, respectively. 56.9% continue to teach their trainees to perform it.

Conclusions:

Significant heterogeneity exists with regard to the practice, indications, and perceived outcomes of performing a concurrent MCP procedure during CMC arthroplasty. While a substantial proportion of training programs teach the technique, its use varies based on surgeon preference. Larger and comparative studies examining outcomes are necessary to standardize the treatment algorithm for CMC osteoarthritis with MCP hyperextension.