Surgery for thumb (trapeziometacarpal joint) osteoarthritis

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Hand Surgery

Background:

• Surgery is a common treatment for persistent pain and dysfunction at the base of the thumb.
• Previous reviews have not identified a superior surgical technique for trapeziometacarpal osteoarthritis.

Purpose of the Study:

• To compare the effectiveness of different surgical techniques for trapeziometacarpal osteoarthritis at 12 months and 5 years.
• To evaluate outcomes including pain, physical function, patient global assessment, range of motion, and strength.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Included nine studies with 477 participants comparing seven different surgical procedures.
• Assessed risk of bias and extracted data on efficacy and adverse effects.

Main Results:

• No surgical procedure demonstrated superiority in reducing pain or improving function, range of motion, or patient global assessment.
• Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had a higher rate of adverse effects (22%) compared to trapeziectomy (10%).
• The majority of included studies had an unclear risk of bias, limiting definitive conclusions.

Conclusions:

• Current evidence does not support one surgical technique over another for treating trapeziometacarpal osteoarthritis.
• Trapeziectomy appears to be associated with fewer complications than trapeziectomy with LRTI.
• Further high-quality research is needed to definitively compare surgical outcomes.