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A Comparative Analysis of Surgical Treatment for First Carpometacarpal Osteoarthritis: A Systematic Review and Pooled
Justin Le1, Nazanin Kermanshahi2, Jason Tran1
1Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA.
Background:
First carpometacarpal osteoarthritis (CMC1-OA) is a common degenerative condition causing pain, functional loss, and reduced grip strength. While trapeziectomy remains the standard surgical treatment, reconstructive procedures and implant arthroplasties are increasingly used. However, differences in postoperative recovery between these approaches remain unclear. This study provides an indirect pooled comparison of reconstructive, non-reconstructive, and dual-mobility implant procedures for CMC1-OA.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, randomized controlled trials (RCTs) evaluating surgical treatment of CMC1-OA were included. Procedures were categorized as reconstructive, non-reconstructive, or dual-mobility implants. Outcomes included visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand, hand grip, tip pinch, lateral pinch, and complications at 3- and 12-month follow-up.
Results:
Seven RCTs comprising 409 hands were included. At 3 months, dual-mobility implants demonstrated the greatest reduction in VAS pain scores (Δ = 6.05), compared with reconstructive (Δ = 3.52) and non-reconstructive procedures (Δ = 2.86). Disabilities of the Arm, Shoulder, and Hand scores improved across all groups, most prominently in implant procedures (Δ = 29.48 at 3 months; Δ = 35.35 at 12 months). Strength outcomes varied between groups, though implants demonstrated the greatest improvement in lateral pinch strength at 12 months. Complication rates differed between reconstructive (20.61%), implant (24.49%), and non-reconstructive procedures (51.61%), though only 1 study reported complications in the non-reconstructive group.
Conclusion:
Although 12-month pain and functional outcomes were comparable, dual-mobility implants demonstrated greater early improvements in pain, function, and lateral pinch strength. These findings suggest that differences may exist between surgical approaches for CMC1-OA.