Viscosupplementation for the trapeziometacarpal joint: A meta-analysis of current evidence

Nonoperative management of trapeziometacarpal joint osteoarthritis remains centered on either activity modification and intra-articular injections of corticosteroids or viscosupplementation. With increasingly diverse choice for hyaluronic acid (HA) and their derivatives for injectable viscosupplementation, this systematic review and meta-analysis evaluate the therapeutic efficacy of HA injections across specific postoperative timeframes.

In accordance to PRISMA guidelines, a systematic literature search was conducted via MEDLINE and EMBASE, utilizing COVIDENCE for screening. The primary outcome measure was the change in Visual Analog Scale (VAS) pain scores. Fourteen studies involving patients previously active in daily living were included. A meta-analysis was performed to assess the magnitude and significance of VAS score improvements at 3-month and 6-month intervals.

Meta-analysis revealed statistically significant pain reduction at both 3- and 6- months follow up (ΔVAS = 2.38 [95% CI: 0.86, 3.90] for absolute scores and ΔVAS = -2.28 [95% CI: -2.65, -1.90] for change in VAS scores) (ΔVAS = 3.36 [95% CI: 2.36, 4.36] for absolute VAS score and ΔVAS = -2.38 [95% CI: -2.84, -1.93]) respectively. The increase in average VAS score improvement from 3 to 6 months also suggests continued efficacy of HA injections in patient-reported outcomes.

Overall, hyaluronic acid injections provide significant long-term symptomatic relief for trapeziometacarpal joint osteoarthritis. While the data supports HA as a robust non-surgical option, significant heterogeneity across the literature persists. Further standardized, high-quality trials are required to refine clinical protocols and minimize variability in outcomes.

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