Arthrodesis for Carpometacarpal Joint Arthritis: A Systematic Review

Abstract

Background: This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first carpometacarpal joint. Methods: A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Google Scholar. Articles located by the search were independently assessed by title, abstract, or full article review for inclusion or exclusion. Demographic, outcome, and complication data from included articles were extracted, compiled, and analyzed. Frequency-weighted means and proportions were generated. Results: In total, 21 articles met inclusion and exclusion criteria accounting for 802 patients and 914 thumbs. Average age at time of surgery was 55.4 years, and mean follow-up time was 72.7 months. Arthrodesis techniques include Kirschner-wire fixation (51.3%), plate fixation (24.6%), screw fixation (9.8%), tension band technique (7.1%), staple fixation (7.0%), and none (<0.1%). Mean preoperative Disabilities of the Arm, Shoulder and Hand score was 58 and 25.4 postoperatively (∆ = -32.6 points). Mean preoperative visual analogue scale score was 6.8 and 1.9 postoperatively (∆ = -4.9 points). Mean preoperative grip strength was 15.7 kg, and 23.0 kg postoperatively (∆ = +7.3 kg). In all, 48.7% of thumbs had complications, 15.1% of which were major, while 33.6% were minor. The most common major complication was symptomatic hardware (8.6%) requiring return to the operating room, and the most common minor complications were peritrapezial arthritis (8.5%) and nonunion (8.4%). Conclusions: Arthrodesis for arthritis of the trapeziometacarpal joint is associated with good functional outcomes and low to moderate patient-reported disability and pain scores, but a high complication rate. Level of Evidence: IV

Arthrodesis for Eaton-Littler stage III degenerative trapeziometacarpal arthritis: a retrospective comparative study of fixation methods

“…In terms of operative techniques in TM joint arthritis, there are various surgical options and their modifications. Nevertheless, therapeutic challenges remain because no technique guarantees successful outcomes, and the gold standard was not established until now [3]. Eventually, the surgical treatment re-mains largely based on the personal preference of individual surgeons [8,9,16].…”

“…Arthritis of the trapeziometacarpal (TM) joint (also known as the 1st carpometacarpal joint), is one common osteoarthritis in the hand. It is relatively common in middle-aged women, amounting up to 10% of individuals [1][2][3]. A failed conservative treatment needs operative management.…”

Basal thumb arthritis surgery: complications and its management

“…Carpometacarpal (CMC) joint fusion, definitively the least popular procedure for treating basal thumb OA and often reserved for more active and younger patients, has a different spectrum of complications comprising mainly non- and malunion. In the long term, there are further issues involving the STT joint, which add to the variety of complications associated with this specific procedure (Dharamsi et al., 2022).…”

Radial versus dorsal plating for trapeziometacarpal arthrodesis: a comparative biomechanical study

“…The patient satisfaction rate after fusion is reported to be 60%–100% (Kenniston and Bozentka, 2008). Complications such as nonunion (5%–30% of cases) (Rizzo et al., 2009; Vermeulen et al., 2011) and hardware problems (6%–54% of cases) (Dharamsi et al., 2022) remain concerns. Recently, there have been attempts to overcome these problems by various methods, including an additional oblique interfragmentary screw (Pflibsen et al., 2022), bone graft (Muramatsu et al., 2019) and a V-shaped osteotomy (Harston et al., 2015).…”