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Published on: January 24, 2018
Clinical Outcomes of Surgical Options for Base-of-Thumb Arthritis: A Systematic Review and Network Meta-Analysis
Nikki Burnett1, Tim Cheok2, Kenneth Wills1
1Department of Plastics and Reconstructive Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders Drive, Bedford Park, South Australia, Australia.
Purpose:
We investigated the complication profile and effectiveness of arthrodesis, trapeziectomy without suspensionplasty or ligament reconstruction (S/LR), trapeziectomy with S/LR, and joint replacement (JR) for the management of base-of-thumb arthritis. We included cases of interposition material placement within the trapeziectomy without the S/LR group.
Methods:
A systematic search of PubMed, Embase, and Web of Science was performed from their date of inception to November 2024. The primary complication outcome of interest was the reoperation risk, whereas the primary efficacy outcomes of interest were the pain score measured using a visual analog scale (VAS), Kapandji Opposition Score, and Disability of the Arm, Shoulder and Hand (DASH) or QuickDASH score at the end of the follow-up period. Network meta-analysis was performed. Surface under cumulative ranking (SUCRA) values were computed for studies published within the past 2 decades to rank each group against outcomes of interest, resulting in an approximate summary of the rank distribution of each intervention. A higher SUCRA value, therefore, indicates a better ranking. Cluster analysis was then used to provide an overall recommendation, balancing the risks and benefits of the procedure.
Results:
Seventy-one studies were included in the final analysis. SUCRA values for reoperation risk in the arthrodesis, trapeziectomy without S/LR, trapeziectomy with S/LR and JR groups were 1.3%, 66.4%, 98.2%, and 34.1%, respectively. Likewise, the SUCRA values for each of these groups (in the same order) were 45.5%, 18.0%, 44.7%, and 91.7% for VAS pain scores; 0.0%, 76.8%, 34.4%, and 88.8% for Kapandji Opposition Score; and 2.0%, 44.9%, 53.2%, and 99.9% for DASH or QuickDASH score.
Conclusions:
Trapeziectomy with or without S/LR had a lower reoperation risk and improved patient-reported outcome measures. Balancing the modest improvement in impairment measures against a high reoperation risk, there is still insufficient evidence to recommend the routine use of JR.
Type Of Study/Level Of Evidence:
Therapeutic IV.