Trapeziectomy versus joint replacement for first carpometacarpal (CMC 1) joint osteoarthritis: a systematic review and meta-analysis

Abstract

Purpose This systematic review and meta-analysis directly compares joint replacement (JR) and trapeziectomy techniques to provide an update as to which surgical intervention is superior for first carpometacarpal (CMC-1) joint osteoarthritis. Methods In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (QDASH) and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation and revision surgery rates, were also measured. Results From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QDASH scores were lower for patients in the JR group (five studies, p = 0.0004). Similarly, significantly better postoperative key pinch strength in favour of JR was noted (three studies, p = 0.001). However, pain (VAS) scores were similar between the two groups (five studies, p = 0.21). Moreover, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.12; 95% CI 1.13–3.96, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06–12.81, p = 0.0004). Conclusion Overall, based on very low- to moderate-quality evidence, JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.

Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Follow-Up of Long-Term Clinical Outcomes

“… 29 Implant arthroplasty is prone to early failure. 4 All of the listed methods include substantial downtime with a delayed return to work and orthosis fabrication of around 6 weeks. Carpometacarpal joint denervation, in comparison, has minimal downtime.…”

“… 1 There are a spectrum of surgical options for patients with CMC arthritis, including CMC arthroscopy with debridement, trapeziectomy with or without ligament reconstruction and tendon interposition, trapeziectomy with implant suspensionplasty, arthrodesis, and implant arthroplasty. 3 , 4 , 5 While these procedures are associated with improvements in pain and functional outcomes, there is a substantial risk of postoperative complications, such as tendon rupture; loosening, extrusion, or failure of protheses; and worsening carpal instability. A review of the literature shows that rates of adverse outcomes or postoperative complications can be as high as 22%.…”

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis

“…Higher medium-term key pinch strength seems to be a great advantage of a TMJ implant arthroplasty (Lee et al, 2021;Raj et al, 2022). The higher strength achieved after Touch V R implant arthroplasty can be explained by the ability of this device to restore biomechanical function.…”

Common Hand Conditions

“…71 All surgical techniques have demonstrated efficacy in pain relief and functional improvement. [72][73][74] A 2015 Cochrane review by Wajon et al 73 reported that of 7 surgical techniques, none was associated with better outcomes than alternative techniques for outcomes of functioning and pain.…”

“…In the US, the most commonly performed technique is trapeziectomy with ligament reconstruction and tendon interposition (>90%), followed by trapeziectomy alone, joint replacement, and fusion, all performed at a similar frequency . All surgical techniques have demonstrated efficacy in pain relief and functional improvement . A 2015 Cochrane review by Wajon et al reported that of 7 surgical techniques, none was associated with better outcomes than alternative techniques for outcomes of functioning and pain.…”