Recurrence of Dupuytren's contracture: A consensus-based definition

Hester J Kan, Frank W Verrijp, Steven E R Hovius, Christianne A van Nieuwenhoven, Dupuytren Delphi Group, Ruud W Selles, Hester J Kan, Frank W Verrijp, Steven E R Hovius, Christianne A van Nieuwenhoven, Dupuytren Delphi Group, Ruud W Selles

Abstract

Purpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence.

Methods: To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren's research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic.

Results: Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as "more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment". In addition, "recurrence should be reported individually for every treated joint" and afterwards measurements should be repeated and reported yearly.

Conclusion: This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram.
Fig 1. Flow diagram.
Figure showing shows the number of experts who were included in the study rounds and their country of origin.

References

    1. Kan HJ, Verrijp FW, Huisstede BM, Hovius SE, van Nieuwenhoven CA, Selles RW. The consequences of different definitions for recurrence of Dupuytren's disease. J Plast Reconstr Aesthet Surg. [Review]. 2013. January;66(1):95–103. doi:
    1. Becker GW, Davis TR. The outcome of surgical treatments for primary Dupuytren's disease—a systematic review. J Hand Surg Eur Vol. [Comparative Study Review]. 2010. October;35(8):623–6. doi:
    1. Cheng HS, Hung LK, Tse WL, Ho PC. Needle aponeurotomy for Dupuytren's contracture. J Orthop Surg (Hong Kong). 2008. April;16(1):88–90.
    1. Brotherston TM, Balakrishnan C, Milner RH, Brown HG. Long term follow-up of dermofasciectomy for Dupuytren's contracture. Br J Plast Surg. 1994. September;47(6):440–3.
    1. van Rijssen AL, Ter Linden H, Werker PM. 5-year results of randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plastic and reconstructive surgery. 2011. October 7.
    1. Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease. The Journal of hand surgery. [Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 2010. December;35(12):2027–38 e1. doi:
    1. Ketchum LD, Hixson FP. Dermofasciectomy and full-thickness grafts in the treatment of Dupuytren's contracture. The Journal of hand surgery. 1987. September;12(5 Pt 1):659–64.
    1. Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. The Journal of hand surgery. [Clinical Trial, Phase II Randomized Controlled Trial]. 2010. April;35(4):534–9, 9 e1. doi:
    1. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. [Review]. 2000. October;32(4):1008–15.
    1. Ellis B, Bruton A. A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand. Clin Rehabil. 2002. Aug;16(5):562–70. doi:
    1. Hueston JT. Table top test. Med J Aust. [Letter]. 1976. July 31;2(5):189–90.
    1. Hovius SE, Kan HJ, Smit X, Selles RW, Cardoso E, Khouri RK. Extensive percutaneous aponeurotomy and lipografting: a new treatment for Dupuytren disease. Plastic and reconstructive surgery. 2011. July;128(1):221–8. doi:
    1. Skoff HD. The surgical treatment of Dupuytren's contracture: a synthesis of techniques. Plast Reconstr Surg. 2004. February;113(2):540–4. doi:
    1. van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. J Hand Surg [Am]. 2006. May-Jun;31(5):717–25.
    1. Abe Y, Rokkaku T, Ofuchi S, Tokunaga S, Takahashi K, Moriya H. An objective method to evaluate the risk of recurrence and extension of Dupuytren's disease. Journal of hand surgery. [Comparative Study]. 2004. October;29(5):427–30.
    1. Pratt AL, Byrne G. The lived experience of Dupuytren's disease of the hand. J Clin Nurs. 2009. June;18(12):1793–802. doi:
    1. Lea RD, Gerhardt JJ. Range-of-motion measurements. The Journal of bone and joint surgery American volume. [Review]. 1995. May;77(5):784–98.

Source: PubMed

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