Outcome of Dupuytren's Disease Contractures after Collagenase Clostridium Histolyticum Injection: A Single Institution Experience

Background: Clostridium histolyticum collagenase (CHC) injection is an alternative to surgery for patients with Dupuytren's disease (DD) contractures of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The success of surgical and non-surgical treatment modalities for DD is reported to vary widely between 25-80%. This study presents the outcome of patients with DD contractures treated with CHC injections.

Methods: A retrospective study was conducted of patients with DD contractures of the hand treated with CHC injections in a single institution since its FDA approval from February 2010 to October 2014. All patients received the recommended dose of 0.58mg of CHC reconstituted per manufacturer guidelines. All patients returned one day after injection for joint manipulation under local nerve blocks. Data for follow up at 7 and 30 days post-op and up to 3.5 years for patients who return seeking further therapy for recurrent symptoms were reviewed.

Results: Ninety-eight patients with a total of 120 joints (55 MCP; 65 PIP) were treated with CHC injections from February 2010 to October 2014 (84 males; 14 females; age 40-92). Successful CHC therapy was observed in 75% of injected joints (90/120 joints; 48 MCP; 42 PIP), as defined by <5 degrees contraction after treatment. Eighteen percent of treated joints had partial correction (22/120 joints; 7 MCP; 16 PIP), as defined by between 5 to 30 degrees contraction after treatment. Six patients returned to the clinic seeking additional therapy for recurrent joint contracture symptoms for 6 joints (6/120, 5%; 2 MCP; 4 PIP) over a span of 2 months to 3.5 years. Four joints (3.3%) required additional therapy within one year, 1 joint (1%) recurred within the second year, and 1 joint (1%) required additional therapy in the third year after treatment. Recurrence was defined as a return of >20 degrees contraction in the setting of a palpable cord after initial treatment.

Discussions: Our three-year outcome of CHC injections for DD contractures revealed full correction in 75% and partial correction in 18% of treated patients. 5% of the patients returned for additional therapy due to symptoms from contracture recurrence. These results are comparable to current surgical treatment modalities. The use of CHC injections is an important non-surgical treatment alternative for DD contractures of the MCP and PIP joints.