Clinical Outcomes of Collagenase Injections During a Surgeon’s Initial Learning Phase

Abstract

Purpose: There has been increasing use of collagenase clostridium histolyticum (CCH) for treating Dupuytren contracture since its FDA approval in 2010. One concern among practitioners is the learning curve of this new technique. This study characterizes the success and complication rates for the first 10 injections performed by 10 surgeons who had no prior experience with CCH treatment. Methods: Ten Hand and Upper Extremity fellowship-trained orthopedic surgeons were recruited for this study. Retrospective clinical records for the first 10 CCH injections by each surgeon were reviewed. Pre-injection, post-manipulation, and 30 to 90 days follow-up measurements were recorded, along with complications and Dupuytren treatment history. Finally, provider opinions regarding CCH for Dupuytren contracture were collected. Results: The study reports 100 CCH injections in 100 fingers: 42 with isolated metacarpophalangeal (MP) contractures, 24 with isolated proximal interphalangeal (PIP) contractures, and 34 with both MP and PIP contractures. At 30 to 90 days follow-up, 61.4% of primary joints demonstrated improvement of fixed-flexion contracture (FFC) to within 0-5 degrees from full extension, 85.2% showed >50% reduction in contracture, and 12 cases were lost to follow-up. Analysis of clinical outcomes did not demonstrate statistically significant trends with increasing surgeon experience. Complications occurred in 33 cases and included skin tears (31) and lymphadenopathy (4). No tendon ruptures were observed. All surgeons were either satisfiedor extremely satisfied (4 or 5 out of 5-point scale) with CCH, and all surgeons would recommend CCH for an appropriate new Dupuytren contracture patient. Conclusions: Clinical results achieved from practitioners’ early injections mirrored success, complication, and surgeon satisfaction rates previously reported in literature. Trends in clinical outcomes among the first 10 injections suggest an initially flat learning curve for CCH. Practitioners’ opinions of CCH remained favorable after early use, with surgeons opting for CCH treatment over open surgery when possible.