Thumb CMCJ prosthetic total joint replacement: a systematic review.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Thumb carpometacarpal joint (CMCJ) arthritis is a prevalent and debilitating condition.
• Prosthetic replacement is a surgical option to restore thumb biomechanics, alleviate pain, and enhance function.
• Previous reviews highlighted a scarcity of high-quality evidence, necessitating an updated assessment.

Purpose of the Study:

• To systematically review and synthesize the current evidence on thumb CMCJ prosthetic total joint replacement outcomes.
• To evaluate patient-reported outcome measures (PROMs), pain, range of motion, strength, survival rates, and complications.
• To compare prosthetic replacement with alternative treatments like resection arthroplasty.

Main Methods:

• A systematic literature review was performed adhering to PRISMA guidelines.
• Databases were searched for studies evaluating thumb CMCJ prosthetic total joint replacement outcomes.
• Data extraction included PROMs, pain scores, range of motion, strength, survival rates, and complications from 56 eligible studies (2731 patients, 3048 replacements).

Main Results:

• Overall, thumb CMCJ prosthetic replacement demonstrated significant improvements in PROMs, pain scores, and strength.
• Implant failure rates varied from 2.6% to 19.9% depending on the specific implant.
• Comparative studies indicated that prosthetic replacement yielded modest PROMs improvements over resection arthroplasty but with increased complication rates.

Conclusions:

• The number and quality of studies on thumb CMCJ prosthetic total joint replacement are increasing.
• Implant loosening and dislocation remain concerns, though appear reduced with modern implants compared to older designs.
• While functional outcomes are promising compared to resection arthroplasty, further high-quality research with standardized techniques and outcomes is recommended.