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Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A
Chul-Ho Kim1, Dong-Hoon Lee2, Jae-Sung Lee3
1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Purpose:
Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.
Methods:
We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.
Results:
Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], -0.05; 95% CI, -0.40 to 0.30; P = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, -1.12 to 2.17; P = .53), and grip strength (SMD, -0.67; 95% CI, -1.85 to 0.51; P = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32-0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00-32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11-3.91; I2 = 0%) compared with the LRTI group.
Conclusions:
Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.
Type Of Study/Level Of Evidence:
Therapeutic II.
