Objective Improvements, Subjective Uncertainty: Surgical Outcomes and the Role of PROMIS in Severe PIP Contractures

Background: Severe proximal interphalangeal (PIP) contractures in Dupuytren disease significantly impair hand function and quality of life. Surgical correction is common, but the relationship between improved joint mobility and patient-reported outcomes remains unclear. This study evaluated surgical outcomes for severe PIP contractures and assessed patient-reported function using Patient-Reported Outcomes Measurement Information System (PROMIS). Methods: A retrospective chart review included patients with severe PIP contractures treated surgically. Contractures were categorized by severity: group 1 (<29°), group 2 (30°-59°), group 3 (60°-89°), and group 4 (>90°). Objective outcomes were measured as contracture reduction at multiple time points (preoperative, immediate postoperative, and final follow-up) using a goniometer. The PROMIS scores for pain intensity, daily activity interference, and upper extremity function were collected preoperatively and at final follow-up. Statistical analyses included descriptive statistics, paired t tests, and analysis of variance with post hoc Tukey tests ( P < .05). Results: The study included 60 digits from 48 patients. Significant contracture reductions were observed across all groups, averaging more than 60%. However, PROMIS scores did not consistently reflect improvements in pain, activity interference, or upper extremity function. A significant decrease in upper extremity function was noted in group 3 (60°-89°). No operative complications or reoperations occurred. Conclusions: Surgical correction markedly improves joint contracture but does not consistently enhance PROMIS-reported outcomes. These results question PROMIS applicability in this context and highlight the need for alternative assessment tools to better address functional recovery in patients with severe PIP contractures.