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¿Es la Denervación Articular un Tratamiento Duradero para la Osteoartritis del Trapecio-Metacarpiano del Pulgar? Un
Niek J Nieuwdorp1,2,3, Camille Blaaker1, Esmee Kwee1
1Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.
Background:
Joint denervation for thumb carpometacarpal (CMC) osteoarthritis (OA) remains less commonly used, primarily due to concerns about the long-term durability of symptom relief. This study aimed to assess the long-term reoperations and outcomes after CMC denervation and to identify prognostic factors associated with postoperative pain.
Methods:
This multicenter prospective study included patients with thumb CMC OA who underwent joint denervation. The primary outcome was the rate of reoperation due to recurrent CMC joint symptoms. Secondary outcomes included long-term pain and hand function measured using the Visual Analogue Scale (VAS, 0-100), as well as patient satisfaction.
Results:
A total of 69 patients (76 thumbs) undergoing CMC denervation were included. In 30% of cases, an additional partial wrist denervation (AIN and PIN) was performed for CMC OA. After a median follow-up of 30 months (range: 6-110), 28% underwent reoperation for recurrent CMC joint complaints, with a median time to reoperation of 9 months. VAS pain and function scores improved significantly by 3 months and remained stable long-term among those not requiring reoperation. At long-term follow-up, 66% of patients without reoperation would choose to undergo denervation again. Additional partial wrist denervation (p=0.001) and STT-involvement (p=0.042) were associated with less pain improvement, while male patients improved more (p=0.023).
Conclusions:
Joint denervation is an effective and durable treatment for CMC OA, with 72% not undergoing reoperation and reporting sustained improvements in pain and function. Additional partial wrist denervation (AIN and PIN) did not show superior results and is therefore not recommended.Level of Evidence: Therapeutic, II.
