title: The influence of evidence in the surgical treatment of thumb basilar joint arthritis.
abstract: BACKGROUND
  For surgical treatment of thumb carpometacarpal joint arthritis, current evidence suggests that simple trapeziectomy is as effective as and may be safer than trapeziectomy and ligament reconstruction with or without tendon interposition. The authors examined whether current practice patterns in the surgical treatment of thumb carpometacarpal joint arthritis reflect adoption of simple trapeziectomy as best practice, and investigated whether surgeon preferences and third-party payer patterns are associated with use of simple trapeziectomy.
  
  
  METHODS
  The authors performed a retrospective cross-sectional study of 6776 surgical treatments for thumb carpometacarpal joint arthritis using the all-payer State Ambulatory Surgery Database for Florida, from 2006 to 2009. Multinomial regression analysis was applied to examine associations between covariates, describing surgeon and third-party payer factors and type of procedure performed. An intraclass correlation coefficient was calculated to determine how much of the difference in patient outcome (procedure type) is attributable to differences between surgeons.
  
  
  RESULTS
  Across surgeon characteristics included in the analysis, patients' outcome probabilities were over 90 percent in favor of treatment with trapeziectomy and ligament reconstruction with or without tendon interposition. The level of intraclass correlation among patients clustered within a surgeon showed that individual surgeons contribute substantially to determining what procedure type a patient undergoes.
  
  
  CONCLUSIONS
  In this multiyear, one-state study, current evidence demonstrating the equivalent effectiveness of simple trapeziectomy compared with more involved alternatives did not result in wide adoption of the technique. This finding is consistent with studies in many clinical disciplines that highlight the difficulty of influencing clinical practice with available evidence.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Department of Pediatrics and Internal Medicine, University of Michigan Health System, and the University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Sonya
authors.initials: S
authors.lastname: DeMonner
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D001168:Arthritis / Q000601:surgery*; D052737:Carpometacarpal Joints / Q000601:surgery*; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013933:Thumb / Q000601:surgery*
references.citation: Hand (N Y). 2007 Dec;2(4):232-9
references.pmid: 18780059
references.citation: Soc Sci Med. 2002 Nov;55(10):1771-7
references.pmid: 12383461
references.citation: Plast Reconstr Surg. 2004 Aug;114(2):421-32
references.pmid: 15277809
references.citation: Hand Clin. 1987 Nov;3(4):489-505
references.pmid: 3693418
references.citation: J Hand Surg Am. 1986 May;11(3):324-32
references.pmid: 3711604
references.citation: Health Aff (Millwood). 2005 Jan-Feb;24(1):18-28
references.pmid: 15647212
references.citation: Med Care. 1994 Mar;32(3):202-13
references.pmid: 8145598
references.citation: Med Care. 2001 Aug;39(8 Suppl 2):II46-54
references.pmid: 11583121
references.citation: Clin Orthop Relat Res. 1970 May-Jun;70:191-9
references.pmid: 5445726
references.citation: J Hand Surg Am. 2012 Mar;37(3):411-7
references.pmid: 22305824
references.citation: J Hand Surg Br. 2000 Aug;25(4):350-6
references.pmid: 11058002
references.citation: J Eval Clin Pract. 2011 Aug;17(4):819-26
references.pmid: 20704631
references.citation: J Hand Surg Eur Vol. 2007 Aug;32(4):462-6
references.pmid: 17399871
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004631
references.pmid: 16235371
references.citation: Ann Rheum Dis. 1969 Sep;28(5):Suppl:47-55
references.pmid: 5379851
references.citation: Perspect Biol Med. 2005 Autumn;48(4):490-501
references.pmid: 16227662
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD004631
references.pmid: 19821330
references.citation: J Hand Surg Br. 1985 Feb;10(1):115-6
references.pmid: 3998589
references.citation: Ann Rheum Dis. 2011 Sep;70(9):1581-6
references.pmid: 21622766
references.citation: J Hand Surg Br. 2005 Feb;30(1):45-9
references.pmid: 15620491
references.citation: J Hand Surg Eur Vol. 2009 Jun;34(3):312-21
references.pmid: 19321528
references.citation: Can J Surg. 2003 Aug;46(4):279-84
references.pmid: 12930105
references.citation: JAMA. 1999 Oct 20;282(15):1458-65
references.pmid: 10535437
references.citation: J Hand Surg Am. 2004 Nov;29(6):1069-77
references.pmid: 15576217
references.citation: J Hand Surg Am. 1986 May;11(3):309-24
references.pmid: 3711603
references.citation: Hand. 1981 Oct;13(3):246-50
references.pmid: 7319325
references.citation: J Bone Joint Surg Br. 1949 Nov;31B(4):537-9, illust
references.pmid: 15397137
references.citation: J Bone Joint Surg Br. 1949 Nov;31B(4):540-2, illust
references.pmid: 15397138
references.citation: J Bone Joint Surg Am. 1995 Mar;77(3):346-55
references.pmid: 7890782
references.citation: Hand Clin. 2001 May;17(2):207-21
references.pmid: 11478043
references.citation: J Hand Surg Br. 1997 Dec;22(6):689-94
references.pmid: 9457566
references.citation: Plast Reconstr Surg. 2008 Aug;122(2):505-515
references.pmid: 18626369
references.citation: Surg Clin North Am. 2006 Feb;86(1):1-16, vii
references.pmid: 16442417
references.citation: J Hand Surg Am. 2011 Jan;36(1):157-69
references.pmid: 21193136
references.citation: Sci Transl Med. 2010 Jun 23;2(37):37cm18
references.pmid: 20574065
references.citation: J Eval Clin Pract. 2008 Oct;14(5):707-13
references.pmid: 19018899
references.citation: J Hand Surg Br. 1993 Aug;18(4):533-9
references.pmid: 8409675
references.citation: Am J Med. 1999 Nov;107(5):437-49
references.pmid: 10569298
references.citation: J Am Acad Orthop Surg. 2008 Mar;16(3):140-51
references.pmid: 18316712
references.citation: Plast Reconstr Surg. 2011 Jul;128(1):199-207
references.pmid: 21399560
references.citation: Am J Epidemiol. 2002 Dec 1;156(11):1021-7
references.pmid: 12446258