Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons |
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Authors: | Christi M Cavaliere Adam J Oppenheimer Kevin C Chung |
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Institution: | (1) Section of Plastic Surgery, Department of Surgery, University of Michigan and VA Ann Arbor Health System, Robert Wood Johnson Clinical Scholar, Ann Arbor, MI, USA;(2) Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA;(3) Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA;(4) University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340, USA; |
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Abstract: | Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical
intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted
to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management
of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with
survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values
were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand
surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected
gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between
two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery. |
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Keywords: | Utilities Physician perspectives Wrist fusion Wrist arthroplasty |
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