Additional Treatment after Collagenase Injections and Needle Fasciotomy for Dupuytren's Disease: A Retrospective Cohort Study
Denise Arnold, BA1; Jonathan Lans, MD1; Ritsaart F Westenberg, MD2; Philip E. Blazar, MD3; Neal C Chen, MD2
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Massachusetts General Hospital, Boston, MA, 3Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
Background:
Minimal invasive treatments for Dupuytren's disease have gained increasing interest since FDA approval of collagenase injections. The aim of this study was to assess the rate of additional treatment after collagenase injection and needle fasciotomy for Dupuytren's disease, and what factors are associated with additional procedures for recurrent contractures.
Methods: Using Current Procedure Terminology codes we retrospectively identified adult patients that underwent collagenase injection (n=244) or needle fasciotomy (n=25) for Dupuytren's disease from 2010 to 2014 at a single institutional system. Patients had a median age of 68 years (IQR:61-74) and were followed for a median of 59 months (IQR:46-74). Through a medical chart review we collected information regarding patient demographics and treatment characteristics. Additional treatment was categorized as (1) for recurrence, an increase in contracture compared to post-treatment of the same ray and (2) for persistence, a persistent contracture of the same ray after initial treatment. To evaluate factors associated with additional treatment we performed a bivariate analysis and multivariable logistic regression.
Results: Additional treatment for recurrence after collagenase injection was performed in 23% of the fingers at a median of 23 months (IQR:7.8-39.7) and 11% of patients underwent additional treatment for a persistent contracture at a median of 1.9 months (IQR:1.1-3.0). Twenty-seven percent of the patients had >1 collagenase injection. Younger age (OR: 0.97, 95% CI: 0.94-1.00, p=0.036) and bilateral disease (OR:3.7, 95% CI:1.57-8.71, p=0.003) were independently associated with additional treatment for recurrence after collagenase injection. In the patients that underwent needle fasciotomy 10% of the fingers had treatment for recurrence at a median of 28.2 months (IQR:27.5-28.2) and 10% of the fingers required additional treatment for persistent disease at a median of 26.8 months (IQR:1.1-68.7). No factors associated with additional treatment after needle fasciotomy were identified. The only difference identified between fingers treated with collagenase injection and needle fasciotomy was that those treated with needle fasciotomy were more likely to undergo open fasciectomy, 13% vs. 5.8% (p=0.015).
Conclusion: Additional treatment after collagenase injections was performed in 34% of the fingers and was associated with bilateral disease and younger age, indicative of aggressive disease. After needle fasciotomy, one fifth of the patients underwent additional treatment, and secondary fasciectomy was performed more commonly compared to the additional treatments performed after collagenase injection.
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