The influence of socioeconomic status and psychological factors on surgical outcomes of the carpometacarpal osteoarthritis of the thumb. / Influencia de los factores socioeconómicos y psicológicos en los resultados del tratamiento quirúrgico de la artrosis trapecio-metacarpiana.

ABSTRACT

OBJECTIVE: This study aimed to investigate to what extent people with carpometacarpal thumb osteoarthritis that are socioeconomically disadvantaged and have psychological disorders report higher pain levels and worse patient-rated upper-extremity functionality after surgical treatment. MATERIAL AND METHOD: A single center, retrospective observational cohort study analysing 100 patients diagnosed with thumb carpometacarpal osteoarthritis between 2013 and 2019. Patients were divided into two groups (50/50), depending on whether they received surgical or conservative treatment. The socio-economic status (ESeC classification) and presence of psychological comorbidities were investigated. Functional outcomes were assessed using the Visual Analogue Scale (VAS), Q-DASH questionnaire and Kapandji score. Current mental disorders were evaluated using STAI, PHQ-9 and PCS screening scales. RESULTS: Measures of functional hand scores (Q-DASH) were higher and had considerably less pain in surgically treated participants, although thumb mobility (Kapandji) was more restricted. They were also associated with higher scores on psychological assessment scales. Sixty-four per cent of the patients came from lower socio-economic classes and suffered from poorer scores on the mental health screening questionnaires. Of the patients manage surgically, 54% were diagnosed of dysthymic disorder and showed significantly worse patient-rated upper-extremity function (Q-DASH questionnaire, median [IR]31,8 [20,5-54,6] than patients without psychological disorders (median [IR] 13,6 [2,3-36,5]). No differences were found for patients with and without disthymic disorder managed nonoperatively. CONCLUSIONS: Patients with higher rates of depression, anxiety and pain catastrophizing behaviour showed significantly worse outcomes after surgery for osteoarthritis of the first carpometacarpal joint. Lower socio-economic class significantly influences levels of depression and anxiety but did not affect functional outcome. Surgical treatment of carpometacarpal thumb osteoarthritis achieved better self-perceived hand function (QDASH, VAS, Kapandji) than conservative treatment.