Study into common health condition compares surgery to less invasive treatment

Researchers have compared the effectiveness of surgery over a less invasive injection for the treatment of a common health condition.

Dupuytren’s Contracture - in which one or more fingers become permanently bent towards the palm – is believed to affect around 2 million people in the UK and is more prevalent in men and those aged 50 or over. 

It is caused when fibrous cords form in the hand, which progressively shorten, pulling one or more fingers into a bent position and interfering with hand movement. Treatment is typically via surgery but collagenase injections are also an option to help break down the cord of thickened tissue and allow the fingers to be straightened. 

Now a team of researchers, led by Professor Joseph Dias from the University of Leicester and a consultant orthopaedic surgeon at University Hospitals of Leicester NHS Trust, have published the results of a trial in the New England Journal of Medicine which compared Limited Fasciectomy Surgery to a Collagenase injection on the affected hand. 

The trial assessed nearly 700 patients with a moderate contracture of at least 30 degrees who were randomly assigned to receive either an injection or surgery.

Results were measured by follow-up questionnaire and scored using a Patient Evaluation Measure (PEM) ranging from 0 to 100, with higher scores indicating worse outcomes, at one year after treatment. 

The results showed that the mean score on the PEM at one year was 17.8 among those who received surgery, compared to 11.9 among those who received the injection. Those who received surgery also reported greater improvement in their hand function.

Furthermore, re-operation of Dupuytren’s Contracture was more prevalent in those who received the injection – 14.6%, compared to 3.4%.

Speaking about the results, Professor Dias said: “The study aimed to provide more concrete information on the benefits and drawbacks of treatment options for Dupuytren’s Contracture because data comparing the two approaches was lacking. 

“These new findings show that while collagenase injection is less invasive and can be performed in a clinic instead of an operating room with a quicker recovery time, it does have a higher proportion of repeat treatments and has less successful outcomes for returning hand function and movement.

“There were some advantages to the collagenase injection in terms of a lower risk of moderate to severe complications and longer time to improvement associated with surgery but over-all the percentage of patients with complications did not differ substantially between the treatment groups.”

Professor Dias cited some limitations to the study, stating that at different points treatment was affected by substantial changes to the provision of care in treatment sites and follow-up due to the Covid-19 pandemic.

He said: “Some recurrences and reinterventions may not have been captured. Therefore, longer term follow-up is needed to better assess the progression of contracture.” 

The study was conducted with the assistance of the York Trials Unit at the University of York and was funded by the NIHR.