Page 60 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints

Chapter 3
The decision to operate on a patient is mostly determined by clinical symptoms and the results of previous therapy. However, at present, selection of the surgical technique is strongly dependent on the personal preference of the surgeon. For example, most US hand surgeons (62%) would treat patients with Eaton stage III with a trapeziectomy with LRTI,19 while the most preferred treatment in this situation by Dutch colleagues was hemitrapeziectomy.16 CT can be beneficial for those clinicians who prefer to treat their patients with hemitrapeziectomy, CMC arthrodesis or joint replacement procedures, since it is often not possible to evaluate the STT joint surgically during these procedures. Therefore, it is important to have ruled out STT OA before the operation. The increased detection of STT OA with CT may improve treatment selection. In clinical practice CT could therefore be indicated for those patients who are eligible for thumb base surgery and who showed no radiographical OA in the STT joint.
Multiple systematic reviews examined the optimal surgical technique for CMC1 OA, and concluded that there is insufficient evidence to determine a superior operating technique in terms of patient outcome.2-4 These reviews and almost all of the studies included, did not take into account the presence or absence of STT OA or the Eaton stage. As described by Eaton in 1987, patients with different Eaton stages will probably benefit from different types of surgery.13 Wajon et al. therefore advised future studies to group patients into Eaton stages to determine the most appropriate procedure for each stage.4 As CT imaging may be more precise in determining the Eaton stage than radiography, it could improve the detection of Eaton stage-specific treatment effects in future surgical trials.
This study has limitations. As this was a retrospective study, we could only collect limited data. For example, it would have been interesting to compare our results with intra-operative findings in patients who had surgery. However, the severity of osteoarthritis was mostly not documented in the surgical reports. Selection bias may be present, as we do not know the exact reason for referral for each patient. All the included patients however, were referred from our hand surgery outpatient clinic, and these patients are usually only referred when they are suspected of having severe symptomatic thumb base OA eligible for surgery. The results might have been different if more patients with less severe thumb base OA (Eaton stages I and II) had been included.
58