JHS Spotlight, Part 1: Basal joint arthritis, telemedicine, and GLPs

Chuck and Chris begin a new initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena will choose the articles from the previous quarter and Chris and Chuck will review the articles and discuss practical implications.  This first episode includes discussion of the following articles from Q4 of 2025:

Portney DA, Lee CP, Wolf JM, Strelzow JA, Stepan JG. A Changing Landscape in Surgical Treatment of Basilar Thumb Arthritis: Is the Rate of Denervation Increasing? J Hand Surg Am. 2025 Oct;50(10):1280.e1-1280.e8. PMID: 39918526.

Earp BE, Zhang D, Benavent KA, Ostergaard PJ, Blazar PE. The Use of Telemedicine Postoperative Visits Following Carpal Tunnel and Trigger Digit Releases: A Randomized Clinical Trial. J Hand Surg Am. 2025 Dec;50(12):1431-1437. PMID: 41117725.

Amen TB, Ibrahim LI, Gillinov SM, Torabian KA, Dean MC, Liimakka A, Lee SK. Glucagon-like peptide-1 Agonists and Common Hand Procedures: Perioperative and Postoperative Risks and Complications. J Hand Surg Am. 2025 Nov;50(11):1297-1303. PMID: 41055617.

We are in need of a podcast intern!  We would appreciate any referrals!

See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.

The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.

As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Transcript

Meeting summary 

Quick recap

Charles and Christopher discussed their recent podcast episode, which featured a new segment reviewing three articles from the Journal of Hand Surgery. They explored the use of telemedicine for post-operative visits, the impact of GLP-1 agonists on hand surgery patients, and trends in the surgical treatment of basilar thumb arthritis. The hosts shared their experiences with these topics and discussed the implications for their practices. 

Summary

Hand Surgery Practice Insights

Charles and Christopher discussed their recent experiences with reading and preparing for social gatherings. They then focused on a new partnership with the Journal of Hand Surgery, where Nash and Macarena selected six key articles for profiling. Charles shared insights from a site visit to an Atlanta orthopedic practice, highlighting the efficiency of joint surgeons like Charlie DeCook, who performs multiple total joint replacements in a single session. They briefly touched on the potential for increased efficiency in hand surgery practices, despite the greater diversity of cases.

Enhancing Surgical Efficiency Through Parallel Processing

Charles shared insights from a recent visit to a high-efficiency surgery center, emphasizing that surgeon efficiency is the key bottleneck and that parallel processing, rather than sequential steps, significantly improves throughput. He noted that while hospital leadership was receptive to the concepts, implementation would require dedicated resources and cultural changes. Christopher raised concerns about potential misalignment between hospital systems and surgeons' incentives, while Charles suggested that transparent communication with patients about surgery volumes and efficiency improvements can be beneficial, as long as quality remains unchanged.

Christopher and Charles discussed a study on telemedicine for post-operative visits following carpal tunnel and trigger finger releases. The study, conducted by Harvard's Brigham team, randomized 60 patients to either in-person or telehealth follow-ups, finding similar patient satisfaction levels between the two methods. Christopher shared his experience offering telemedicine follow-ups for patients with dissolvable sutures, noting a 20% conversion rate from in-person to telemedicine visits. While praising the study's execution, Christopher suggested that the Press Ganey survey tool, used as the primary outcome measure, might not be the most specific tool for assessing patient experience after these specific procedures.

They then examined a study on GLP-1 agonists and their impact on hand surgery outcomes, concluding that these medications do not increase perioperative risks. Finally, they analyzed a trend study on surgical treatments for basilar thumb arthritis, noting an increase in denervation procedures but predicting a future rise in prosthetic arthroplasty. The discussion highlighted the evolving landscape of hand surgery and the importance of considering patient preferences and emerging treatments.