A meta-analysis of surgical interventions for base of thumb arthritis

Challoumas, D., Murray, E., Ng, N., Putti, A. and Millar, N. (2022) A meta-analysis of surgical interventions for base of thumb arthritis. Journal of Wrist Surgery, 11(6), pp. 550-560. (doi: 10.1055/s-0042-1743117) (PMID:36504527) (PMCID:PMC9731743)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Murray, Dr Elspeth and Challoumas, Mr Dimitris and Millar, Professor Neal and Ng, Dr Nigel
• Authors: Challoumas, D., Murray, E., Ng, N., Putti, A., and Millar, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Journal of Wrist Surgery
• Publisher: Georg Thieme
• ISSN: 2163-3916
• ISSN (Online): 2163-3924
• Published Online: 23 February 2022
• Copyright Holders: Copyright © 2022 Georg Thieme
• First Published: First published in Journal of Wrist Surgery 11(6):550-560
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher