Dupuytren's Contracture - Recurrence

Recurrence

Dupuytren’s disease has a high recurrence rate, especially when a patient has so called Dupuytren’s diathesis. The term diathesis relates to certain features of Dupuytren's disease and indicates an aggressive course of disease.

The initial description of Dupuytren’s disease diathesis included 4 factors:

• the patient is below the age of 50 years old
• positive family history
• both of the hands are affected
• ectopic lesions (Peyronie's disease, Knuckle pads and Ledderhose disease).

In a study of Hindocha et al. they reevaluated these 4 factors and modified them. The original factors of family history, bilateral Dupuytren’s disease, and ectopic lesions now include 2 additional factors: male gender and age at onset of younger than 50 years. The presence of all new Dupuytren’s disease diathesis factors in a patient increases the risk of recurrent Dupuytren’s disease by 71% compared with a baseline risk of 23% in those Dupuytren’s disease patients with none of the earlier-described factors. In another study the prognostic value of diathesis was evaluated. They concluded that presence of diathesis can predict recurrence and extension. A scoring system was made to evaluate the risk of recurrence and extension containing the following values: bilateral hand involvement, little finger surgery, early onset of disease, plantar fibrosis, knuckle pads and radial side involvement.

Minimal invasive techniques may show higher recurrence rates. However there is no consensus on what recurrence is, different definitions are used. Furthermore different standards for recurrence are used and different ways to measure these.