Abstract
Purpose
To perform an updated systematic review investigating the various surgical and injection interventions for thumb carpometacarpal (CMC) joint arthritis.
Methods
A systematic literature search was conducted in MEDLINE, Embase, Web of Science, and Cochrane databases from inception to April 2024 to identify prospective, randomized studies comparing surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months. Reference lists of previous reviews were screened to identify additional publications. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference) because of marked heterogeneity of data and inadequate statistical power. Cochrane’s risk of bias 2 tool assessed the quality of included studies.
Results
Seventeen studies encompassing 1,166 thumbs were included in this review. Fourteen studies compared surgical interventions, whereas three studies compared various intra-articular injections. Five studies had a low risk of bias, eight had a moderate risk of bias, and four had a high risk of bias. Regarding primary outcomes, there was no difference in function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis. Arthrodesis was associated with a higher complication rate compared with trapeziectomy. Platelet-rich plasma injections had improved pain, function, and patient satisfaction outcomes compared with corticosteroid injections.
Conclusions
No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Platelet-rich plasma injections may be a useful alternative to corticosteroids in first CMC osteoarthritis.
Type of study/level of evidence
Therapeutic IB.
Key words: Function, Hand, Pain, Surgery, Treatment
Thumb carpometacarpal (CMC) joint osteoarthritis, also known as base of thumb arthritis or trapeziometacarpal arthritis, is a prevalent condition that significantly impairs hand function and quality of life, particularly among the elderly and postmenopausal women.1 The CMC joint is crucial for thumb opposition and pinching, and its degeneration can lead to severe pain, functional limitations, and disability.2 As the population ages, the incidence of this debilitating condition is expected to rise, highlighting the need for effective management strategies.1
Conservative management of CMC joint osteoarthritis typically includes nonsteroidal anti-inflammatory drugs, corticosteroid injections, and splinting, which aim to alleviate pain and inflammation but often provide only temporary relief.3,4 When conservative treatments fail, surgical interventions may become necessary. The traditional surgical approach has been trapeziectomy, with or without ligament reconstruction and tendon interposition (LRTI), which has long been considered the standard of care.5,6 This procedure involves removing the trapezium and stabilizing the thumb metacarpal using harvested tendons, which purportedly helps reduce pain and improves functional efficiency.5 However, newer surgical techniques, such as arthroscopy, osteotomy, and various forms of arthroplasty, have emerged. These techniques aim to provide similar or better outcomes with potentially fewer complications and faster recovery.7
Joint injections are alternatives to traditional surgery.8 These include intra-articular injections of substances like hyaluronic acid, platelet-rich plasma (PRP), or corticosteroids. Platelet-rich plasma and fat grafting have shown promise in early studies, demonstrating potential benefits in pain reduction and functional improvement because of their regenerative properties.9 Despite the growing interest, the effectiveness and long-term outcomes of these minimally invasive treatments compared with traditional surgical options still need to be determined.
The existing literature presents a mixed picture regarding the comparative effectiveness of different surgical and minimally invasive interventions for CMC joint osteoarthritis. Studies have shown variable outcomes about pain relief, functional improvement, and complication rates, making it difficult for clinicians to determine the most appropriate treatment for their patients.10 Moreover, the lack of standardized reporting and variability in study designs further complicates the evidence synthesis. Since the previous systematic review on the topic more than a decade ago, there have been a plethora of studies comparing various interventions for thumb CMC joint osteoarthritis.11 Therefore, the present study aimed to perform an updated systematic review comparing outcomes of various surgical techniques and minimally invasive interventions in patients with thumb CMC joint arthritis with a follow-up of at least 12 months.
Methods
This review followed the preferred reporting items for systematic reviews and meta-analyses guidelines and was registered on the International Prospective Register of Systematic Reviews. Two reviewers (S.B. and L.W.) independently performed the title and abstract screen, full-text review of eligible studies, data extraction, and risk of bias assessment. Discrepancies were resolved by consensus or with a third reviewer’s involvement if required.
Search strategy
A systematic literature search was conducted across MEDLINE, Embase, Web of Science, and Cochrane databases from inception to 26 April 2024 with no language restrictions using the following search terms in the Title and Abstract fields: (“thumb carpometacarpal joint” or “first carpometacarpal joint” or “trapeziometacarpal joint”) and (“osteoarthritis” or “arthritis” or “rhizarthrosis”) and (“surgery” or “surgical intervention∗” or “minimally invasive intervention∗” or “treatment” or “therap∗” or “arthrodesis” or “arthroplasty” or “trapeziectomy” or “ligament reconstruction” or “LRTI” or “steroid injection” or “CSI” or “corticosteroid injection” or “PRP” or “platelet-rich plasma” or “hyaluronic acid” or “denervation” or “osteotomy” or “prolotherapy”). Reference lists of previous reviews were screened to identify additional relevant publications.
Eligibility criteria
Prospective, parallel-arm, randomized studies (blinded and unblinded) comparing different surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months were eligible for inclusion. Interventions of interest included arthrodesis, arthroplasty, trapeziectomy with or without soft tissue reconstruction, denervation, osteotomy, and steroid, hyaluronic acid, or PRP injections. In this study, arthroplasty refers to joint replacement with prosthetic implants. Retrospective studies, nonrandomized prospective studies, narrative reviews, case reports, case series, studies with no comparator groups, studies investigating only noninvasive interventions such as hand or physical therapy, studies with noninvasive interventions as control groups, studies comparing different implants or techniques (eg, cemented versus uncemented arthroplasty, different spacer devices, and various tendon interposition techniques) instead of broad surgical categories (eg, trapeziectomy, arthroplasty, denervation, etc) were excluded.
Outcomes
The following outcomes were investigated as reported in individual studies: pain, functional outcomes, range of motion, strength, and complications. Cochrane’s risk of bias 2 tool assessed the quality of included studies.
Data analysis
Because of limited data available for some secondary outcomes across studies, the decision was not to pool results in a meta-analysis as any such analysis would be fundamentally underpowered. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference). Clinically significant differences in primary outcomes were considered clinically relevant if there was a difference of at least 15 points in the visual analog scale for pain, 15 points in disabilities of the arm, shoulder, and hand score, and 0.5 kg for key pinch strength, as used previously.12
Results
Of 1,321 unique hits identified by our search, 17 studies encompassing 1,166 thumbs were included in this review (Fig. 1; Table 1).6,9,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 Fourteen studies,compared surgical interventions, whereas three studies compared minimally invasive techniques.6,9,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Of the surgical interventions, six compared trapeziectomy to trapeziectomy with LRTI; three studies compared trapeziectomy with arthroplasty; two compared arthrodesis and trapeziectomy; one compared partial trapeziectomy to total trapeziectomy; one compared trapeziectomy and LR with trapeziectomy with LRTI; and one compared trapeziectomy to denervation.6,14, 15, 16,18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Regarding minimally invasive interventions, one study compared autologous fat with PRP injections; one corticosteroid with hyaluronic acid injections; and one PRP with corticosteroid injections.9,13,17
Figure 1.
Flow diagram outlining the screening and exclusion process.
Table 1.
Characteristics of Included Studies
| Study | Study Period | n Thumbs | Loss to Follow-Up (%) | Mean Age (y) | % F | Follow-Up (mo) | Blinding | Eaton-Littler Stage | Grade I (%) | Grade II (%) | Grade III (%) | Grade IV (%) | Exclusion Criteria | Interventions Compared |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| de Jong et al14 | 2014–2018 | 62 | 3 | 60 | 100 | 12 | Double | II–III | 0 | 25 | 37 | 0 | Previous operations for CMC joint OA, posttraumatic OA, RA, SLE, gout, STT arthrosis, CTS, de Quervain tenosynovitis, neurological disorders affecting the hand | 1. Trapeziectomy 2. Arthroplasty |
| Guzzini et al15 | 2017–2020 | 150 | 2 | 67 | 81 | 24 | Single | II–III | - | - | - | - | STT arthrosis, poor bone quality radiologically, RA | 1. Trapeziectomy + TI 2. Arthroplasty |
| Thorkildsen et al21 | 2008–2016 | 40 | 10 | 62.5 | 70 | 24 | Single | II–IV | 0 | 2.5 | 95 | 2.5 | STT arthrosis, large trapezial cysts, injuries of the thumb or carpus | 1. Trapeziectomy + LRTI 2. Arthroplasty |
| Belcher and Nicholl25 | 1996–1998 | 43 | 3 | 60 | 88 | 14 | Unblinded | - | - | - | - | - | RA, patient undergoing another procedure at the same time | 1. Trapeziectomy 2. Trapeziectomy + LRTI |
| Brennan et al6 | 2001–2003 | 65 | 43 | 76 | 79 | 210 | - | III–IV | - | - | - | - | - | 1. Trapeziectomy 2. Trapeziectomy + LRTI |
| Field and Buchanan24 | 2001–2003 | 65 | 0 | 55 | 86 | 12 | - | III–IV | 0 | 0 | 45 | 55 | - | 1. Trapeziectomy 2. Trapeziectomy + LRTI |
| Gangopadhyay et al26 | 1992–2001 | 153 | 5.6 | 57 | 100 | Minimum 72 | Unblinded | II–IV | - | - | - | - | - | 1. Trapeziectomy 2. Trapeziectomy + TI 3. Trapeziectomy + LRTI |
| Hart et al27 | 1995–2002 | 40 | 0 | 59 | 65 | 81.6 | Single | IV | 0 | 0 | 0 | 100 | RA, posttraumatic arthritis, previous thumb operation, coexistent hand pathology | 1. Trapeziectomy + LRTI 2. Arthrodesis |
| Kriegs-Au et al16 | 1995–1998 | 52 | 28 | 59 | 81 | 48.2 | Single | II–IV | 16 | 71 | 13 | RA, posttraumatic arthritis, previous thumb operation, coexistent hand pathology | 1. Trapeziectomy + LR 2. Trapeziectomy + LRTI | |
| Salem and Davis18 | 2002–2005 | 131 | 11 | - | 85 | 72 | Unblinded | - | - | - | - | - | - | 1. Trapeziectomy 2. Trapeziectomy + LRTI |
| Zarezadeh et al23 | 2019–2021 | 70 | 20 | 55 | 68 | 12 | Single | - | - | - | - | - | RA, previous joint surgery | 1. Trapeziectomy 2. Trapeziectomy + LRTI |
| Vermeulen et al22 | 2008–2011 | 38 | 0 | 59 | 100 | 12 | Single | II–III | 0 | 34 | 66 | 0 | RA, posttraumatic arthritis, previous thumb surgery | 1. Trapeziectomy + LRTI 2. Arthrodesis |
| Salibi et al19 | 2005–2013 | 55 | 18 | 59 | 76 | 60 | Unblinded | - | - | - | - | - | Previous base of thumb surgery | 1. Trapeziectomy 2. Trapezial denervation |
| Sánchez-Flò et al20 | 2014–2015 | 34 | 6 | 60.5 | 82 | 12 | Single | II–III | 0 | 27 | 73 | 0 | Cognitive impairment, posttraumatic OA, MCPJ hyperextension | 1. Partial trapeziectomy 2. Total trapeziectomy |
| Bahadir et al13 | - | 40 | - | 62 | 100 | 12 | Single | II–III | - | - | - | - | Previous fracture, CTS, previous surgery or major trauma to hand, inflammatory systemic diseases, de Quervain tenosynovitis, any previous injection | 1. Steroid injection 2. Hyaluronic acid injection |
| Malahias et al17 | 2012 – 2014 | 33 | 3 | 63 | 79 | 12 | Single | I-III | - | - | - | - | Systemic rheumatic disease, CTS, de Quervain tenosynovitis, history of gout or pseudogout, bleeding predisposition, previous surgery to the affected thumb, previous injection to the thumb base within past 12 months, no evidence of CMC joint space narrowing on plain radiographs | 1. Steroid injection 2. PRP injection |
| Winter et al9 | 95 | 6 | 64 | 84 | 24 | Single | I-IV | 1.1 | 21 | 60 | 18 | Pregnancy or lactation, CTS, de Quervain tenosynovitis, STT arthrosis, rheumatoid arthritis, multiple joint OA of the hand not involving the first CMC joint | 1. Autologous fat injection 2. PRP injection 3. Autologous fat + PRP injection 4. Saline injection |
CMC, carpometacarpal; CTS, carpal tunnel syndrome; OA, osteoarthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; STT, scapho-trapezium-trapezoid.
Risk of bias
Table 2 summarizes the risk of bias assessment for included studies. Overall, five studies were deemed to have a low risk of bias.9,14,17,20,21 There were some methodological concerns in eight studies, stemming mainly from issues in the “intervention deviation” domain. The remaining four studies had a high risk of bias, primarily because of bias in the “result selection” and “intervention deviation” domains. 6,13,15,16,18,19,22, 23, 24, 25, 26, 27
Table 2.
Risk of Bias Assessment for Included Studies According to Cochrane’s Risk of Bias 2 Tool for Randomized Trials.
| Study | Domain |
Overall Result | ||||
|---|---|---|---|---|---|---|
| Randomization | Intervention Deviations | Missing Data | Outcome Measurement | Result Selection | ||
| Bahadir et al13 | Some concerns | Low | Low | Low | Some concerns | Some concerns |
| Belcher and Nicholl25 | Low | Some concerns | Low | Low | Some concerns | Some concerns |
| Brennan et al6 | Low | Some concerns | Some concerns | Low | Low | Some concerns |
| de Jong et al14 | Low | Low | Low | Low | Low | Low |
| Field and Buchanan24 | Low | Some concerns | Low | Low | Low | Some concerns |
| Gangopadhyay et al26 | Low | Some concerns | Some concerns | High | High | High |
| Guzzini et al15 | Low | Some concerns | Low | Some concerns | Some concerns | Some concerns |
| Hart et al27 | Some concerns | Some concerns | Low | Some concerns | High | High |
| Kriegs-Au et al16 | Low | Some concerns | Some concerns | Low | Low | Some concerns |
| Malahias et al17 | Low | Low | Low | Low | Low | Low |
| Salem and Davis18 | Low | Some concerns | Low | Low | Low | Some concerns |
| Salibi et al19 | High | High | High | Low | Low | High |
| Sánchez-Flò et al20 | Low | Low | Low | Low | Low | Low |
| Thorkildsen and Røkkum21 | Low | Low | Low | Low | Low | Low |
| Vermeulen et al22 | Low | High | Low | Low | Low | High |
| Winter et al9 | Low | Low | Low | Low | Low | Low |
| Zarezadeh et al23 | Low | Some concerns | Some concerns | Low | Low | Some concerns |
Outcomes
Only five studies reported primary outcomes: pain, function, and key pinch strength.9,14,20, 21, 22 Of these, the study by Vermeulen et al,22 was terminated prematurely owing to higher complications in the arthrodesis group. These include, among others, nonunion requiring additional surgery (n = 2) and complex regional pain syndrome (n = 1). Therefore, results from only four studies, which also had the lowest risk of bias, were adequately powered to compare interventions. However, the data needed to be more amenable to pooling in a meta-analysis due to disparate interventions studied and measured outcomes, leading to a qualitative synthesis (Table 3).6,9,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 There was no difference in long-term function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis.14,20, 21, 22 Patients undergoing arthrodesis experienced more complications such as delayed union and nonunion compared with the trapeziectomy group.22 No difference in pain or function was observed between trapeziectomy and denervation.19 Changes in secondary outcomes are illustrated in Table 3.6,9,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27
Table 3.
Summary of Outcomes in Included Studies∗
| Study | Group 1 | Group 2 | Group 3 | Primary Endpoint | Specific Outcomes |
Satisfaction | |||
|---|---|---|---|---|---|---|---|---|---|
| Function | Strength | Movement | Pain | ||||||
| de Jong et al14 | Trapeziectomy | TJA | - | ND | ND | Improved key pinch strength (1.2kg difference) | Improved flexion (6.7o difference) and decreased extension (10o difference) | - | Decreased (63% vs 88%) |
| Guzzini et al15 | Trapeziectomy + TI | TJA | - | - | ND | Improved grip strength (25.2kg vs 32kg), pinch strength (2.5kg vs 4.3 kg), and key pinch strength (5.2kg vs 6.6kg) | ND | ND | - |
| Thorkildsen and Røkkum21 | Trapeziectomy + LRTI | TJA | - | ND | ND | ND | Improved extension (42o vs 47o) and abduction (42o vs 49o) | - | Decreased (95% vs 90%) |
| Belcher and Nicholl25 | Trapeziectomy | Trapeziectomy + LRTI | - | - | - | ND | - | ND | - |
| Brennan et al6 | Trapeziectomy | Trapeziectomy + LRTI | - | - | ND | ND | Decreased extension (79o vs 71o) | - | - |
| Field and Buchanan24 | Trapeziectomy | Trapeziectomy + LRTI | - | - | - | ND | Decreased abduction (70o vs 62o) | ND | - |
| Gangopadhyay et al26 | Trapeziectomy | Trapeziectomy + TI | Trapeziectomy + LRTI | - | - | ND | - | - | - |
| Hart et al27 | Arthrodesis | Trapeziectomy + LRTI | - | - | - | - | - | - | - |
| Kriegs-Au et al16 | Trapeziectomy + LR | Trapeziectomy + LRTI | - | - | - | - | Decreased extension (43o vs 39o) and abduction (42o vs 38o) | - | - |
| Salem and Davis18 | Trapeziectomy | Trapeziectomy + LRTI | - | - | ND | ND | - | - | - |
| Zarezadeh et al23 | Trapeziectomy | Trapeziectomy + LRTI | - | - | ND | Decreased pinch strength (5.4kg vs 4.7kg) | - | ND | - |
| Vermeulen et al22 | Trapeziectomy + LRTI | Arthrodesis | - | ND | ND | ND | ND | - | Decreased (86% vs 53%) |
| Salibi et al19 | Trapeziectomy | Denervation | - | - | ND | - | - | ND | - |
| Sánchez-Flò et al20 | Partial trapeziectomy | Total trapeziectomy | - | ND | ND | ND | - | ND | - |
| Bahadir et al13 | Steroid injection | Hyaluronic acid injection | - | - | ND | ND | - | ND | - |
| Malahias et al17 | PRP injection | Steroid injection | - | - | Worse (Q-DASH 20.4 vs 43) | - | - | Worse (VAS 2 vs 6.5) | Decreased (69% vs 12.5%) |
| Winter et al9 | Saline injection | PRP | Autologous fat + PRP | Improved | Improved (Q-DASH reduction 15.9 in group 3 compared with group 1) | - | - | Improved in group 3 compared to group 1 | - |
DASH, Disabilities of the Arm, Shoulder and Hand score; ND, no difference; VAS, Visual Analog Scale.
Changes in outcome reflect a change in group 2 relative to group 1 unless stated otherwise.
Discussion
This systematic review found no surgical intervention superior to another in managing thumb CMC joint osteoarthritis. The study’s strengths include rigorous inclusion criteria that selected randomized studies with relatively long follow-up periods, thereby allowing better determination of an intervention’s longevity.
We found no difference in outcomes between trapeziectomy and arthroplasty. Although this is consistent with most existing literature, some suggest superior key pinch strength and thumb opposition with arthroplasty.4,11,12,28, 29, 30, 31, 32 However, these latter reviews included retrospective and nonrandomized prospective studies with significant heterogeneity in their pooled analyses, necessitating caution in their interpretation. Arthroplasty may be associated with better grip strength and thumb movement; however, any such benefits must be weighed against higher complication and revision surgery rate compared with trapeziectomy.32,33 A comparative review of complications of trapeziectomy and arthroplasty by Latelise and colleagues, who included all studies reporting a complication following either procedure, irrespective of study design or follow-up, found that 6% of patients undergoing trapeziectomy experienced severe complications such as thumb collapse and metacarpophalangeal hyperextension. By contrast, approximately one in every four patients who underwent arthroplasty experienced a severe complication such as dislocation, loosening, or wear.33 The associated revision rates were 2% for the trapeziectomy group and 13% for the arthroplasty group.33 In our study, no difference in complication rate between the two groups was observed. Partial trapeziectomy was introduced to preserve healthy joints and prevent first-ray collapse, maximizing thumb length. However, this joint-sparing technique did not provide any advantage over trapeziectomy 1 year after surgery. Overall, the results from this study and previous reviews suggest comparable clinical outcomes between trapeziectomy and arthroplasty, with a possibly higher complication profile associated with arthroplasty.
The addition of soft tissue reconstruction (TI, LR, or LRTI) to augment trapeziectomy is intended to prevent loss of postoperative strength, thumb shortening, and scaphoid impingement.5 Similar to results reported previously, we found no benefit in soft tissue reconstruction besides trapeziectomy for the base of thumb osteoarthritis (OA).4,5,11,12,28,30,34 Our analysis of secondary outcomes suggests reduced thumb movement, pinch strength, and functional outcomes and greater complications such as tendon rupture or tethering, sensory loss, instability, and pain with soft tissue augmentation.6,16,18,23, 24, 25 However, the number of complications in each study needed to be bigger to provide any measure of significance. Taken together, results from this study and previous reviews suggest that soft tissue augmentation to trapeziectomy may not offer additional benefits as initially conceived.
Trapeziometacarpal arthrodesis is thought to provide a relatively stable thumb at the cost of manual dexterity.10 We found arthrodesis inferior to trapeziectomy in terms of function and range of motion. Consistent with previous studies, arthrodesis was associated with more complications than other surgical modalities. Complications specific to arthrodesis included delayed union or nonunion requiring additional surgery, with nonunion rates of 8% to 21% reported in the literature.11 Although this renders arthrodesis a less useful surgical modality for treating first CMC joint OA in most patients, it may still be helpful in specific patient cohorts, such as those with hypermobility or Ehlers-Danlos syndrome. Comparative evidence in these groups of patients still needs to be provided.
Injections for first CMC joint osteoarthritis include a range of bioactive substances, such as corticosteroids, hyaluronic acid, and PRP, that can be used for intra-articular injections. No clear algorithm exists for the choice of intra-articular injection type in patients with early to moderate-stage osteoarthritis. We found no difference in outcomes between corticosteroid or hyaluronic acid injections regarding pain, function, or grip strength at 1 year.13 On the other hand, patients injected with PRP reported improved function and pain compared with corticosteroid injection, with higher overall satisfaction over a similar time frame.17 The latter study included an unknown proportion of patients with early-stage arthritis (Eaton-Littler grade I), which may have influenced the differential treatment response because of the high concentration of growth factors and other mediators in PRP that augment the natural inflammatory response, especially during early stages of the disease. Although the combination of PRP and autologous fat resulted in the most significant reduction in pain compared with saline, no direct comparison with other injection modalities besides saline was made.9 It is also important to acknowledge the presence of studies that demonstrate no discernible differences in functional outcomes and pain scores between corticosteroid injections and saline placebos, suggesting that intra-articular injections, regardless of substance or dose, may amount to a placebo effect.35 Given the absence of findings of clear superiority among injection types, corticosteroids’ affordability, safety, and familiarity position them as pragmatic and viable treatment options for the management of base of thumb arthritis. The most optimum dose and type of corticosteroids remains a poorly explored area with limited capacity for pooled analyses, given short study follow-up periods and heterogeneity of treatment.4,35 Furthermore, without strong evidence, avoiding injections altogether or using saline or local anesthetic as low-cost, low-risk alternatives for short-term relief may be reasonable considerations. Future studies with larger cohorts, standardized protocols, and more extended follow-up periods are needed to clarify the role of intra-articular injections and establish clear evidence-based recommendations.
Results from this study must be interpreted in the context of some limitations. First are those attributed to the included studies’ intrinsic design, that is, single-blind or unblinded design, single center location, and small sample sizes. For example, due to patients’ perception of denervation being a less-invasive procedure, recruitment into the randomized study by Salibi et al,91 was markedly impaired as patients self-selected into their group of choice. Therefore, the results from this study are subject to significant selection bias and should be interpreted cautiously. Second is the marked heterogeneity of reported results (eg, different pain and function scores and inconsistent primary outcomes) and interventions (eg, type, frequency, and dosage of intra-articular injections, and varied implants used for arthroplasty), and lack of adequately powered studies that precluded pooling of results via a meta-analysis. The moderate or high risk of bias in most studies reflects this. Third, it is imperative to recognize that age and sex play pivotal roles in influencing outcomes such as grip and pinch strength.36,37 Additionally, anthropometric characteristics have been shown to impact strength.36,38 It needs to be clarified whether studies accounted for these potential confounding factors.
In conclusion, our systematic review reinforces the current paradigm that no surgical intervention was superior to the other for treating the first CMC joint OA. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Corticosteroids remain the most established and readily accessible intra-articular. However, PRP injections are a promising alternative to corticosteroid injections, demonstrating better function and pain outcomes.
Conflicts of Interest
No benefits in any form have been received or will be received related directly to this article.
References
- 1.Teunissen J.S., Wouters R.M., Bierma-Zeintra S.M.A., et al. The prevalence, incidence, and progression of radiographic thumb base osteoarthritis in a population-based cohort: the Rotterdam Study. Osteoarthr Cartil. 2022;30(4):578–585. doi: 10.1016/j.joca.2022.01.003. [DOI] [PubMed] [Google Scholar]
- 2.Zhang Y., Niu J., Kelly-Hayes M., Chaisson C.E., Aliabadi P., Felson D.T. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study. Am J Epidemiol. 2002;156(11):1021–1027. doi: 10.1093/aje/kwf141. [DOI] [PubMed] [Google Scholar]
- 3.Spaans A.J., van Minnen L.P., Kon M., Schuurman A.H., Schreuders A.R., Vermeulen G.M. Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am. 2015;40(1):16–21.e1-6. doi: 10.1016/j.jhsa.2014.08.047. [DOI] [PubMed] [Google Scholar]
- 4.Kroon F.P.B., Carmona L., Schoones J.W., Kloppenburg M. Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis. RMD Open. 2018;4(2) doi: 10.1136/rmdopen-2018-000734. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Li Y.K., White C., Ignacy T.A., Thoma A. Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: A systematic literature review. Plast Reconstr Surg. 2011;128(1):199–207. doi: 10.1097/PRS.0b013e318217435a. [DOI] [PubMed] [Google Scholar]
- 6.Brennan A., Blackburn J., Thomson J., Field J. Simple trapeziectomy versus trapeziectomy with flexor carpi radialis suspension: a 17-year follow-up of a randomized blind trial. J Hand Surg Eur Vol. 2021;46(2):120–124. doi: 10.1177/1753193420952966. [DOI] [PubMed] [Google Scholar]
- 7.Bellemère P. Pyrocarbon implants for the basal thumb arthritis. Hand Surg Rehabil. 2021;40S:S90–S101. doi: 10.1016/j.hansur.2020.08.012. [DOI] [PubMed] [Google Scholar]
- 8.Kask K., Pivato G., Pozzi A., Susini F., Pegoli L. Minimally invasive procedure for the stabilization of the painful “prearthritic” carpometacarpal joint of the thumb. Tech Hand Up Extrem Surg. 2014;18(4):194–198. doi: 10.1097/BTH.0000000000000066. [DOI] [PubMed] [Google Scholar]
- 9.Winter R., Tuca A.-C., Justich I., et al. Minimally invasive treatment of trapeziometacarpal osteoarthritis: results of a blinded randomized controlled trial. Plast Reconstr Surg. 2023;152(6):1277–1285. doi: 10.1097/PRS.0000000000010516. [DOI] [PubMed] [Google Scholar]
- 10.Seth I., Bulloch G., Seth N., Fogg Q., Hunter-Smith D.J., Rozen W.M. Efficacy and safety of different trapezium implants for trapeziometacarpal joint osteoarthritis: a systematic review and meta-analysis. Hand (N Y) 2024;19(8):1242–1251. doi: 10.1177/15589447231183172. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Vermeulen G.M., Slijper H., Feitz R., Hovius S.E.R., Moojen T.M., Selles R.W. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am. 2011;36(1):157–169. doi: 10.1016/j.jhsa.2010.10.028. [DOI] [PubMed] [Google Scholar]
- 12.Challoumas D., Murray E., Ng N., Putti A., Millar N. A meta-analysis of surgical interventions for base of thumb arthritis. J Wrist Surg. 2022;11(6):550–560. doi: 10.1055/s-0042-1743117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Bahadir C., Onal B., Dayan V.Y., Gürer N. Comparison of therapeutic effects of sodium hyaluronate and corticosteroid injections on trapeziometacarpal joint osteoarthritis. Clin Rheumatol. 2009;28(5):529–533. doi: 10.1007/s10067-008-1079-6. [DOI] [PubMed] [Google Scholar]
- 14.de Jong T.R., Bonhof-Jansen E.E.D.J., Brink S.M., de Wildt R.P., van Uchelen J.H., Werker P.M.N. Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial. J Hand Surg Eur Vol. 2023;48(9):884–894. doi: 10.1177/17531934231185245. [DOI] [PubMed] [Google Scholar]
- 15.Guzzini M., Arioli L., Annibaldi A., Pecchia S., Latini F., Ferretti A. Interposition arthroplasty versus dual cup mobility prosthesis in treatment of trapeziometacarpal joint osteoarthritis: a prospective randomized study. Hand (N Y) 2024;19(8):1260–1268. doi: 10.1177/15589447231185584. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.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(2):209–218. doi: 10.2106/00004623-200402000-00001. [DOI] [PubMed] [Google Scholar]
- 17.Malahias M.A., Roumeliotis L., Nikolaou V.S., Chronopoulos E., Sourlas I., Babis G.C. Platelet-rich plasma versus corticosteroid intra-articular injections for the treatment of trapeziometacarpal arthritis: a prospective randomized controlled clinical trial. Cartilage. 2021;12(1):51–61. doi: 10.1177/1947603518805230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Salem H., Davis T.R.C. 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(3):211–219. doi: 10.1177/1753193411414516. [DOI] [PubMed] [Google Scholar]
- 19.Salibi A., Hilliam R., Burke F.D., Heras-Palou C. Prospective clinical trial comparing trapezial denervation with trapeziectomy for the surgical treatment of arthritis at the base of the thumb. J Surg Res. 2019;238:144–151. doi: 10.1016/j.jss.2019.01.011. [DOI] [PubMed] [Google Scholar]
- 20.Sánchez-Flò R., Fillat-Gomà F., Marcano-Fernández F.A., Berenguer-Sánchez A., Balcells-Nolla P., Torner P. Partial versus total trapeziectomy with interposition arthroplasty for trapeziometacarpal osteoarthritis grade II to III Eaton-Littler: a clinical trial. J Hand Surg Global Online. 2020;2(3):133–137. doi: 10.1016/j.jhsg.2020.03.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Thorkildsen R.D., Røkkum M. Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial. J Plast Surg Hand Surg. 2019;53(6):361–369. doi: 10.1080/2000656X.2019.1635490. [DOI] [PubMed] [Google Scholar]
- 22.Vermeulen G.M., Brink S.M., Slijper H., et al. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a randomized controlled trial. J Bone Jt Surg Am. 2014;96(9):726–733. doi: 10.2106/JBJS.L.01344. [DOI] [PubMed] [Google Scholar]
- 23.Zarezadeh A., Dehghani M., Shahruzian A. Ligament reconstruction and tendon interposition in comparison with hematoma distraction arthroplasty for the treatment of arthritis in the trapeziometacarpal joint. Int J Burn Trauma. 2021;11(4):296–303. [PMC free article] [PubMed] [Google Scholar]
- 24.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(4):462–466. doi: 10.1016/J.JHSB.2007.02.005. [DOI] [PubMed] [Google Scholar]
- 25.Belcher H.J., Nicholl J.E. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg Br. 2000;25(4):350–356. doi: 10.1054/jhsb.2000.0431. [DOI] [PubMed] [Google Scholar]
- 26.Gangopadhyay S., McKenna H., Burke F.D., Davis T.R. 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(3):411–417. doi: 10.1016/j.jhsa.2011.11.027. [DOI] [PubMed] [Google Scholar]
- 27.Hart R., Janeček M., Šiška V., Kučera B., Štipčák V. Interposition suspension arthroplasty according to Epping versus arthrodesis for trapeziometacarpal osteoarthritis. Eur Surg. 2006;38(6):433–438. [Google Scholar]
- 28.Saheb R.L.C., Vaz B.A.S., Soeira T.P., Shimaoka F.J., Herrero C.F.P.D.S., Mazzer N. Surgical treatment for rhizarthrosis: a systematic review of the last 10 years. Acta Ortop Bras. 2022;30(1) doi: 10.1590/1413-785220223001e246704. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Knightly N., Sullivan P. Surgery for trapeziometacarpal joint osteoarthritis: A systematic review and meta-analysis of recent literature. J Hand Surg Asian Pac Vol. 2021;26(2):245–264. doi: 10.1142/S2424835521500260. [DOI] [PubMed] [Google Scholar]
- 30.Martou G., Veltri K., Thoma A. Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review. Plast Reconstr Surg. 2004;114(2):421–432. doi: 10.1097/01.prs.0000131989.86319.b1. [DOI] [PubMed] [Google Scholar]
- 31.Lee J.K., Yoon B.H., Lee H.I., Kim C., Choi S., Han S.H. Prosthetic replacement has a clinical outcome superior to that of trapeziectomy with ligament reconstruction and tendon interposition: a meta-analysis. Orthopedics. 2021;44(2):e151–e157. doi: 10.3928/01477447-20210104-06. [DOI] [PubMed] [Google Scholar]
- 32.Qureshi M.K., Halim U.A., Khaled A.S., Roche S.J., Arshad M.S. Trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal joint replacement for thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis. J Wrist Surg. 2022;11(3):272–278. doi: 10.1055/s-0041-1731818. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Latelise B., Ben Brahim E., Prasil L., Freslon M. Complications of prosthesis versus trapeziectomy in trapeziometacarpal joint arthritis: a systematic review. Hand Surg Rehabil. 2024;43(2) doi: 10.1016/j.hansur.2024.101672. [DOI] [PubMed] [Google Scholar]
- 34.Rosales R.S., Gonzalez-Garcia A., Dorta-Fernandez A., Heras-Palou C. A meta-analysis of the outcomes of ligament reconstruction compared to no reconstruction with or without tendon interposition following trapeziectomy for thumb carpometacarpal joint osteoarthritis. J Hand Surg Asian Pac Vol. 2022;27(1):22–31. doi: 10.1142/S2424835522500175. [DOI] [PubMed] [Google Scholar]
- 35.Krez A.N., Wu K.A., Klifto K.M., Pidgeon T.S., Klifto C.S., Ruch D.S. Efficacy of intra-articular corticosteroid injection for nonsurgical management of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. J Hand Surg Am Vol. 2024;49(6):511–525. doi: 10.1016/j.jhsa.2024.02.001. [DOI] [PubMed] [Google Scholar]
- 36.Günther C.M., Bürger A., Rickert M., Crispin A., Schulz C.U. Grip strength in healthy Caucasian adults: reference values. J Hand Surg Am. 2008;33(4):558–565. doi: 10.1016/j.jhsa.2008.01.008. [DOI] [PubMed] [Google Scholar]
- 37.GüNther C.M., BüRger A., Rickert M., Schulz C.U. Key pinch in healthy adults: normative values. J Hand Surg Eur Vol. 2008;33(2):144–148. doi: 10.1177/1753193408087031. [DOI] [PubMed] [Google Scholar]
- 38.Keevil V.L., Luben R., Dalzell N., et al. Cross-sectional associations between different measures of obesity and muscle strength in men and women in a British cohort study. J Nutr Health Aging. 2015;19(1):3–11. doi: 10.1007/s12603-014-0492-6. [DOI] [PMC free article] [PubMed] [Google Scholar]