Trapeziectomy versus Total Joint Arthroplasty: A Comparison of Health Utility Outcomes Collected by the UK Hand Registry.

Abstract

Background: We aimed to evaluate the difference in health utility outcome measures between trapeziectomy and total joint arthroplasty (TJA) in the surgical management of basal thumb osteoarthritis (BTOA). Methods: Data obtained from the UK Hand Registry for all trapeziectomies (± ligament reconstruction and tendon interposition) and total joint arthroplasties for BTOA, including patient-reported outcome measures (PROMs) EQ5D and PEM part 2 scores, at baseline, 3 months, 6 months, 1 year and 2 years postoperatively. EQ5D scores were converted to index values, and PEM part 2 scores were calculated to allow comparison with baseline scores and to generate delta values at each time point. Mann-Whitney U tests were used to determine statistical differences. Results: A total of 948 procedures identified (710 trapeziectomy; 238 TJA), 76% female. More PROMs were collected for trapeziectomy patients at all timepoints (267 EQ5D and 262 PEM-2 at baseline; 27 EQ5D and 26 PEM-2 at 2 years) than for TJA patients (98 EQ5D and 111 PEM-2 at baseline; 8 EQ5D and 18 PEM-2 at 2 years). PEM-2 was significantly improved in the TJA group at 3 months (p = 0.047) and 6 months (p = 0.012); there was no significant difference at subsequent follow-up (1 year, p = 0.611; 2 years, p = 0.438). There was no significant difference in EQ5D identified between trapeziectomy and TJA at any time point (3 months, p = 0.056; 6 months, p = 0.059; 1 year, p = 0.222; 2 years, p = 0.250). Conclusions: TJA appears to offer a faster return of hand function, as measured by PEM-2, when compared with trapeziectomy, though this clinical improvement is not sustained beyond 6 months from this registry data. We identified no significant difference in EQ5D between the two procedures at any time point, though both groups improved from baseline. Greater engagement with the UKHR from surgeons and patients might help to reduce attrition and improve longer-term outcomes reporting. Level of Evidence: Level III (Therapeutic).