Determinants of patient satisfaction 5 years after dual-mobility trapeziometacarpal joint implant arthroplasty

INTRODUCTION: The primary aim of this registry-based case series was to identify determinants of patient satisfaction 5 years after dual-mobility trapeziometacarpal joint (TMJ) implant arthroplasty. Secondary aims included the assessment of 5 year outcomes and implant survival. METHODS: Patients who underwent primary implantation of a dual-mobility TMJ prosthesis were included. Satisfaction at 5 years was assessed using a five-point Likert scale and analysed using a top-box approach. Determinants of being 'very satisfied' were evaluated using univariate logistic regression. Pain (numeric rating scale), hand function (brief Michigan Hand Outcomes Questionnaire, MHQ) and key pinch strength were assessed. Changes in outcomes between baseline and 5 years were analysed using a linear mixed-effects model. Implant survival was estimated using the Kaplan-Meier method. RESULTS: Of the 125 patients who underwent surgery, 108 were available for the 5 year analysis and 94 completed the satisfaction questionnaire. Of the latter, 87 (93%) were 'satisfied' or 'very satisfied' with the treatment outcome. Lower pain levels and higher brief MHQ scores at 5 years were significantly associated with being 'very satisfied'. Baseline characteristics, complications and revision surgery were not associated with satisfaction. Baseline pain, brief MHQ and key pinch strength improved significantly by 5 years. Five revision surgeries occurred, resulting in an estimated 5 year implant survival of 96% (95% CI 92 to100). CONCLUSION: Our results support existing evidence that dual-mobility TMJ arthroplasty yields high patient satisfaction, significant clinical improvement and excellent implant survival at 5 years. Pain relief and improved hand function appear to be key determinants of patient satisfaction. LEVEL OF EVIDENCE: IV.