, Volume 471, Issue 12, pp 3738-3744
Date: 20 Aug 2013

Death, Taxes, and Trapeziometacarpal Arthrosis

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Topic
Hand

Abstract

Background

Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which—it seems safe to assume—most people never seek medical attention.

Questions/purposes

The aims of our study were (1) to confirm the prevalence of radiographic trapeziometacarpal arthrosis in a very large sample and to determine if age and sex are associated with (2) any radiographic evidence of trapeziometacarpal arthrosis; and (3) radiographic evidence of severe trapeziometacarpal arthrosis.

Methods

A total of 2321 patients 31 years or older with radiographs obtained during treatment of a distal radius fracture at a tertiary care medical center emergency department between 2002 and 2012 were analyzed. Trapeziometacarpal arthrosis was graded using the 3-point scale of Sodha et al. (none, definite, destroyed trapeziometacarpal joint); we used regression analyses to determine the association of age (in 10-year age groups) and sex with the presence of trapeziometacarpal arthrosis.

Results

The prevalence of trapeziometacarpal arthrosis steadily increased to 85% between the ages of 71 and 80 years and reached 100% in women (with 50% of them being classified as severe) aged 91 years or older and 93% in men of 81 years or older. Severe arthrosis was more prevalent at earlier ages among women and reached 35% in women and 34% in men who were 81 years or older. Logistic regression identified higher age as the strongest factor associated with trapeziometacarpal arthrosis, but sex was also a factor.

Conclusions

Radiographic trapeziometacarpal arthrosis is an expected part of human aging. Given that only three patients in this large cohort had evidence of prior surgery, it seems that most people adapt to trapeziometacarpal arthrosis. Treatments that optimize adaptation in patients who present with trapeziometacarpal arthrosis-related symptoms and disability merit additional study.

Level of Evidence

Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

One of the authors (SJEB) certifies that she has or may receive payments or benefits, during the study period, greater than USD 10,000 from Anna Foundation|NOREF, Genootschap Noorthey and Stichting Vreedefonds, The Netherlands, for Scientific Research. One of the authors (MGJSH) certifies that he has or may receive payments or benefits, during the study period, greater than USD 10,000 from Anna Foundation|NOREF, and Marti-Keunig Eckhart Stichting, The Netherlands, for Scientific Research. One of the authors (DR) certifies that he has or may receive payments or benefits, during the study period, less than USD 10,000 from Skeletal Dynamics LLC (Miami, FL, USA) and Wright Medical Technology, Inc (Arlington, TN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
A comment to this article is available at http://dx.doi.org/10.1007/s11999-013-3320-0.