Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review

Abstract

This systematic review (SR) aimed to identify the surgical interventions available for trapeziometacarpal osteoarthritis and document their efficacy on pain, physical function, psychological well-being, quality of life, treatment satisfaction, and/or adverse events. Methods: This PROSPERO-registered SR's protocol was developed based on the Cochrane intervention review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Among 9049 potential studies identified,1 SR,18 randomized controlled trials, and 40 nonrandomized controlled trials were included. We identified 11 categories of surgical techniques: first metacarpal osteotomy, first metacarpal and trapezium partial resection, arthrodesis, trapeziectomy (T), Tþligament reconstruction (LR), Tþtendon interposition (TI), Tþligament reconstruction and tendon interposition (LRTI), hematoma distraction arthroplasty (HDA), chondrocostal graft interposition, autologous fat injection, and manufactured implant use. These findings supported by low-quality evidence revealed moderately or largely superior effects of the following interventions: (1) trapeziectomy over TþLRTI using ½ flexor carpi radialis (FCR) and metacarpal tunnel (MT) or using abductor pollicis longus (APL) and FCR for adverse events; (2) trapeziectomy over TþTI using palmaris longus (PL) for pain; (3) TþLR with ½FCR-MT over TþLRTI with ½FCR-MT for physical function; (4) trapeziectomy by anterior approach over that by posterior approach for treatment satisfaction and adverse events; (5) TþLRTI using ½FCR-MTover TþTI with PL for pain; and (6) TþHDA over TþLR using APL-MT-FCR for pain, physical function, and adverse events. GraftJacket (Wright Medical Group, Memphis, TN), Swanson (Wright Medical Group, Letchworth Garden City, UK), and Permacol (Tissue Science Laboratories, Aldershot, UK) implants and hardware (plate/screw) would cause more complications than an autograft. The effect estimates of other surgical procedures were supported by evidence of very low quality. Conclusions: This SR provided evidence of the efficacy of various surgical interventions for trapeziometacarpal osteoarthritis. Some interventions showed a moderate-to-large superior effect on the studied outcome(s) compared with others. However, these findings must be interpreted with caution because of low-quality evidence. To provide stronger evidence, more randomized controlled trials and methodological uniformization are needed. Type of study/level of evidence: Therapeutic I.

Dual mobility prosthesis for trapeziometacarpal osteoarthritis: results from a prospective study of 55 prostheses

“…If patients do not respond to a prolonged comprehensive conservative treatment, including splinting, physiotherapy, anti-inflammatory drugs and change of lifestyle, surgical procedures can be considered. The standard procedure is simple trapeziectomy with ligament reconstruction (Hamasaki et al., 2021; Yeoman et al., 2019). However, trapeziectomy can be associated with reduction of thumb length due to proximal migration of the first metacarpal bone, which may lead to loss of grip and pinch strength (Yang and Weiland, 1998).…”

Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study

“…treatment is a successful treatment strategy for CMC-1 OA, which, on average, reduces pain and improves hand function. 7,8 Moreover, in a large cohort with a mean follow-up of 2.2 years, only 15% of the patients underwent further surgery. 9 Treatment outcomes such as pain relief and functional improvement have been frequently studied; however, in recent days there is increasing attention for the patients' interpretation of their treatment outcomes.…”

Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial

“…We assumed no effect on outcome, so we chose the dorsal approach, for the purpose of avoiding awareness of study group allocation. However, recently Hamasaki et al. (2021) have shown that the dorsal approach is largely inferior to trapeziectomy by an anterior approach in terms of treatment satisfaction and reducing the number of adverse events.…”