Metacarpophalangeal Arthroplasty in Rheumatoid Arthritis: What Determines Satisfaction with Surgery?

LISA A. MANDL, DINA H. GALVIN, JOANNE P. BOSCH, CYNTHIA C. GEORGE, BARRY P. SIMMONS, TEAL S. AXT, ANNE H. FOSSEL, and JEFFREY N. KATZ

ABSTRACT.

Objective. In patients with rheumatoid arthritis (RA), it is unclear what determines satisfaction with metacarpophalangeal (MCP) joint replacement surgery. Previous studies have focused primarily on objective outcomes, such as range of motion (ROM) or strength, although some subjective measures have been examined. We investigate which outcomes most strongly correlate with patient satisfaction.

Methods. We assembled a retrospective cohort of 26 RA patients who received a total of 160 MCP silastic spacer implants. Patients answered a telephone survey, and 18/26 patients were examined. The strength of association between specific outcome variables and patient satisfaction with surgery was measured using Spearman correlations.

Results. Patients had a mean age of 64.8 years and 77% were female. The mean time since surgery was 5.5 years. The strongest determinant of patient satisfaction was postoperative hand appearance (Spearman r ³ 0.60). Pain was also highly correlated with satisfaction with surgery (Spearman r ³ 0.46). Ability to perform activities of daily living and portions of the Jebsen Hand Function Test were moderately correlated with patient satisfaction. Most other measures of hand strength and ROM showed only minimal correlation with patients' overall satisfaction with surgery.

Conclusion. Overall satisfaction with silastic spacer surgery in this cohort of RA patients was most influenced by postoperative hand appearance and by pain. While objective measures of surgical outcomes are valuable reflections of technical success, they are not important determinants of patient satisfaction. The criteria used to assess MCP arthroplasty results should be revised to better capture the outcomes that appear to matter most to patients. (J Rheumatol 2002;29:2488-91)

Key Indexing Terms:

METACARPOPHALANGEAL JOINT
ARTHROPLASTY
RHEUMATOID ARTHRITIS
SATISFACTION

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From the Division of Rheumatology, Immunology and Allergy, Department of Orthopaedic Surgery, Department of Rehabilitation Medicine, Brigham and Women's Hospital; and The Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Disease Center, Boston MA, USA.

Supported by a grant from Wright Medical Technology. Drs. Mandl and Katz are supported by NIH Grant P60 AR47782. Dr. Katz is supported by NIH K24 AR 01213 and a Clinical Science Grant from the Arthritis Foundation. Dr. Mandl is the recipient of a Physician Scientist Award from the Arthritis Foundation.

L.A. Mandl, MD, MPH, Instructor in Medicine; D.H. Galvin, MD, Fellow in Orthopaedics; J.P. Bosch, MSPT, CHT, Staff Physical Therapist; C.C. George, MBA, PT, CHT, Staff Physical Therapist; B.P. Simmons, MD, Associate Clinical Professor of Orthopaedics; T.S. Axt, BA, Research Assistant; A.H. Fossel, Senior Research Associate; J.N. Katz, MD, MS, Associate Professor of Medicine; Brigham and Women's Hospital.

Address reprint requests to Dr. L.A. Mandl, Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, PBB-3, 75 Francis Street, Boston MA 02115.

Submitted October 15, 2001; revision accepted June 28, 2002.

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