Patients’ perspectives of hand function after bilateral trapeziometacarpal surgery: trapeziectomy vs. total joint arthroplasty: A qualitative thematic analysis

Introduction: Conclusive evidence as to whether total joint arthroplasty is better than trapeziectomy for basal thumb arthritis and how this should be measured is still lacking. The aims of our study were to explore patients’ perspectives regarding possible differences in everyday life in those who underwent both procedures, and in what way the Michigan Hand Outcome Questionnaire (MHOQ) reflected these perspectives. Methods: A qualitative study was designed according to a thematical codebook analysis in patients who had bilateral surgery, with total joint arthroplasty on one side and trapeziectomy on the other. Semi-structured interviews were conducted and coded, summarized and merged into themes. Results: Ten participants were interviewed. Median time since trapeziectomy was 5.6 years (range 2.0–16.3) and for total joint arthroplasty was 3.6 years (range 0.7–9.1). Surgical procedure, general functioning, differences between surgical procedures, and MHOQ were identified as the four themes. Irrespective of the type of surgery, participants reported pain reduction, although the majority continued to experience residual pain and loss of strength when performing heavy or forceful activities. The arthroplasty hand was considered superior regarding strength and fine control. Limitations on the body function level of the hand did not lead to limitations at activity and participation level. No relevant differences in activities and participation were mentioned. Substantial variability was observed in MHOQ total scores. The MHOQ could not capture differences between the two types of surgery for fine motor skills, thumb strength, pain intensity or pain-provoking activities. Conclusion: These findings contribute to deeper insight into patients’ perspectives on hand function outcomes after both trapeziectomy and total joint arthroplasty, complementing existing quantitative evidence beyond clinimetrics and patient reported outcome measures.