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

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
› Author Affiliations

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.

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

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Dias R, Chandrasenan J, Rajaratnam V, Burke FD. Basal thumb arthritis. Postgrad Med J 2007; 83 (975) 40-43
  • 2 Cooney III WPIII, Lucca MJ, Chao EY, Linscheid RL. The kinesiology of the thumb trapeziometacarpal joint. J Bone Joint Surg Am 1981; 63 (09) 1371-1381
  • 3 Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am 2005; 87 (12) 2614-2618
  • 4 Riley N, Vella-Baldacchino M, Thurley N, Hopewell S, Carr AJ, Dean BJF. Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis. BMJ Open 2019; 9 (09) e027507
  • 5 Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM. Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015; 40 (01) 16-21.e1–6
  • 6 Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015; (02) CD004631
  • 7 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 8 Higgins JP, Altman DG, Gøtzsche PC. et al; Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
  • 9 Guyatt GH, Oxman AD, Vist GE. et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336 (7650): 924-926
  • 10 van Tulder M, Furlan A, Bombardier C, Bouter L. Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine 2003; 28 (12) 1290-1299
  • 11 Tubach F, Ravaud P, Martin-Mola E. et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: results from a prospective multinational study. Arthritis Care Res (Hoboken) 2012; 64 (11) 1699-1707
  • 12 Beaton DE, Davis AM, Hudak P, Mcconnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now?. Br J Hand Ther 2001; 6 (04) 109-118
  • 13 White IR. Network meta-analysis. Stata J 2015; 15 (04) 951-985
  • 14 Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res 1997; (342) 42-45
  • 15 Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg [Br] 2000; 25 (04) 350-356
  • 16 Tägil M, Kopylov P. Swanson versus APL arthroplasty in the treatment of osteoarthritis of the trapeziometacarpal joint: a prospective and randomized study in 26 patients. J Hand Surg [Br] 2002; 27 (05) 452-456
  • 17 De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004; 9 (01) 5-9
  • 18 Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 2004; 86 (02) 209-218
  • 19 Hart R, Janeck M, Siska V, Kucera B, Stipack V. Interposition suspension arthroplasty according to Epping versus arthrodesis for trapeziometacarpal osteoarthritis. Eur Surg 2006; 38 (06) 433-438
  • 20 Field J, Buchanan D. To suspend or not to suspend: a randomised single blind trial of simple trapeziectomy versus trapeziectomy and flexor carpi radialis suspension. J Hand Surg Eur Vol 2007; 32 (04) 462-466
  • 21 Nilsson A, Liljensten E, Bergström C, Sollerman C. Results from a degradable TMC joint Spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am 2005; 30 (02) 380-389
  • 22 Salem H, Davis TR. Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?. J Hand Surg Eur Vol 2012; 37 (03) 211-219
  • 23 Hansen TB, Stilling M. Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses. A randomized clinical RSA study with 2-year follow-up. Acta Orthop 2013; 84 (01) 98-105
  • 24 Vermeulen GM, Brink SM, Slijper H. et al. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a randomized controlled trial. J Bone Joint Surg Am 2014; 96 (09) 726-733
  • 25 Vermeulen GM, Spekreijse KR, Slijper H, Feitz R, Hovius SE, Selles RW. Comparison of arthroplasties with or without bone tunnel creation for thumb basal joint arthritis: a randomized controlled trial. J Hand Surg Am 2014; 39 (09) 1692-1698
  • 26 Corain M, Zampieri N, Mugnai R, Adani R. Interposition arthroplasty versus hematoma and distraction for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Asian Pac Vol 2016; 21 (01) 85-91
  • 27 Marks M, Hensler S, Wehrli M, Scheibler AG, Schindele S, Herren DB. Trapeziectomy with suspension-interposition arthroplasty for thumb carpometacarpal osteoarthritis: a randomized controlled trial comparing the use of allograft versus flexor carpi radialis tendon. J Hand Surg Am 2017; 42 (12) 978-986
  • 28 Thorkildsen RD, Røkkum M. Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial. J Plast Surg Hand Surg 2019; 53 (06) 361-369
  • 29 Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD. Trapeziectomy alone, with tendon interposition or with ligament reconstruction?. J Hand Surg [Br] 1997; 22 (06) 689-694
  • 30 Gangopadhyay S, McKenna H, Burke FD, Davis TR. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37 (03) 411-417
  • 31 Froschauer SM, Holzbauer M, Hager D, Schnelzer R, Kwasny O, Duscher D. Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study. J Hand Surg Eur Vol 2020; 45 (05) 452-457
  • 32 Klahn A, Nygaard M, Gvozdenovic R, Boeckstyns ME. Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases. J Hand Surg Eur Vol 2012; 37 (07) 605-609
  • 33 Martin-Ferrero M, Simón-Pérez C, Coco-Martín MB, Vega-Castrillo A, Aguado-Hernández H, Mayo-Iscar A. Trapeziometacarpal total joint arthroplasty for osteoarthritis: 199 patients with a minimum of 10 years follow-up. J Hand Surg Eur Vol 2020; 45 (05) 443-451
  • 34 Smeraglia F, Mariconda M, Balato G, Di Donato SL, Criscuolo G, Maffulli N. Dubious space for Artelon joint resurfacing for basal thumb (trapeziometacarpal joint) osteoarthritis. A systematic review. Br Med Bull 2018; 126 (01) 79-84
  • 35 Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am 2009; 34 (01) 20-26
  • 36 Shyamalan G, Jordan RW, Jarvis A. Arthrodesis of the trapeziometacarpal joint using a Chevron osteotomy and plate fixation. Adv Orthop Surg. 2014 ;2014:910257
  • 37 Avisar E, Elvey M, Tzang C, Sorene E. Trapeziectomy with a tendon tie-in implant for osteoarthritis of the trapeziometacarpal joint. J Hand Surg Am 2015; 40 (07) 1292-1297
  • 38 Vermeulen GM, Brink SM, Sluiter J, Elias SG, Hovius SE, Moojen TM. Ligament reconstruction arthroplasty for primary thumb carpometacarpal osteoarthritis (Weilby technique): prospective cohort study. J Hand Surg Am 2009; 34 (08) 1393-1401
  • 39 Ganhewa AD, Wu R, Chae MP. et al. Failure rates of base of thumb arthritis surgery: a systematic review. J Hand Surg Am 2019; 44 (09) 728-741.e10
  • 40 Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (01) 157-169