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J Wrist Surg 2022; 11(06): 550-560
DOI: 10.1055/s-0042-1743117
Survey or Meta-Analysis

A Meta-analysis of Surgical Interventions for Base of Thumb Arthritis

Authors

  • Dimitris Challoumas 

    1   Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
    2   Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr, United Kingdom

  • Elspeth Murray

    3   Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw, United Kingdom

  • Nigel Ng

    3   Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw, United Kingdom

  • Amit Putti

    4   Department of Trauma & Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, United Kingdom

  • Neal Millar

    1   Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Abstract

Background There is a myriad of available surgical options for thumb carpometacarpal joint (CMCJ) arthritis and no robust evidence exists to guide the decisions of treating surgeons. Our aim was to assess the comparative effectiveness of different surgical interventions available for the treatment of thumb CMCJ arthritis.

Methods We performed a systematic review, pairwise, and network meta-analysis of all randomized studies comparing surgical interventions for thumb CMCJ arthritis. Our primary outcomes were pain, function, and key pinch strength at long-term follow-up (> 6 months). Risk of bias and certainty of evidence were assessed for each outcome measure of compared interventions separately. Clinical recommendations were based on evidence of strong or moderate certainty.

Results A total of 17 randomized studies were included in the systematic review. Where possible, pairwise and network meta-analyses were performed. Based on evidence of moderate certainty, trapeziectomy with a concomitant ligament reconstruction and tendon interposition (LRTI) does not appear to be associated with any long-term clinical benefits compared with simple trapeziectomy (function: mean difference [MD] –3.72 [–9.15, 1.71], p = 0.64 favoring simple trapeziectomy; key pinch strength: MD 0.07 kg [–0.28, 0.43], p = 0.68 favoring trapeziectomy with LRTI). Treatment rankings from the network meta-analysis favored trapeziectomy with and without LRTI, joint replacement, and arthrodesis. Trapeziectomy with LRTI appears to be associated with fewer major complications compared with joint replacement and arthrodesis, and more minor complications compared with simple trapeziectomy.

Conclusion Until further high-quality research indicates otherwise, simple trapeziectomy should be the preferred surgical modality for base of the thumb arthritis.

Level of Evidence This is a Level 1 study.

Keywords

thumb - osteoarthritis - surgery - trapeziectomy - suspensioplasty

Ethical Approval

This study was a systematic review and meta-analysis and therefore did not involve patients, for which involvement of an ethical review committee would be required.


Supplementary Material



Publication History

Received: 12 October 2021

Accepted: 04 January 2022

Article published online:
23 February 2022

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