Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities

Kevin C. Chung, Sandra V. Kotsis, H. Myra Kim, Frank D. Burke, E. F.Shaw Wilgis

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Purpose: Previous studies have found that function and pain are the main factors that persuade physicians to recommend surgical reconstruction to patients with rheumatoid arthritis (RA). The factors that influence patients to choose surgical reconstruction, however, are not known fully. The purpose of this study was to determine how function, pain, and aesthetics rank in order of importance to RA patients who are considering metacarpophalangeal (MCP) joint arthroplasty for rheumatoid hand deformities. Methods: Study participants are part of a larger National Institutes of Health-sponsored study. Participants who are eligible to receive MCP joint arthroplasty are enrolled in our study using defined inclusion and exclusion criteria. All patients have RA and MCP joint extensor lag and/or ulnar deviation. Study participants choose whether they want to enroll in a surgical group to receive MCP joint arthroplasty or in a nonsurgical group. At enrollment all participants complete the Michigan Hand Outcomes Questionnaire. Function, pain, and aesthetic domains from the Michigan Hand Outcomes Questionnaire were used in a logistic regression model as predictors to determine the factors associated with patients choosing reconstruction for rheumatoid hand deformities. Results: Younger age and female gender were associated significantly with an increased likelihood for choosing MCP joint arthroplasty surgery. The age- and gender-adjusted odds ratios of choosing MCP joint arthroplasty were 0.50 for function, 1.47 for pain, and 0.83 for aesthetics. Patients with less function and greater pain were more likely to choose MCP joint arthroplasty. Aesthetic consideration was not a statistically significant predictor. Conclusions: Impaired function had the strongest association with patients choosing reconstruction and pain relief was the next most important factor. Although aesthetic consideration was less important, it may prove to be an important factor in determining patient satisfaction after surgery. Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling.

Original languageEnglish (US)
Pages (from-to)289-294
Number of pages6
JournalJournal of Hand Surgery
Issue number2
StatePublished - Feb 2006


  • Arthroplasty
  • Metacarpophalangeal
  • Michigan Hand Outcomes Questionnaire
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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