PURPOSE: Osteoarthritis is a common degenerative condition that can cause pain and swelling in the joints of the hand. Current surgical treatments include osteotomy, arthroplasty, and arthrodesis. However, each of these interventions is invasive and carry inherent limitations such as high-complication rates, altered joint anatomy, and prolonged recovery times. Joint denervation, which involves selective neurectomy of the articular nerve branches to an osteoarthritic joint, has been proposed as a less invasive treatment option. The purpose of this systematic review was to evaluate and report the efficacy and safety of surgical joint denervation for osteoarthritis in joints of the hand.
METHODS: Embase, MEDLINE, and PubMed databases were searched from January 2000 to March 2019. Studies of adult patients with rheumatoid or osteoarthritis of the hand who underwent joint denervation surgery were included. Two independent reviewers performed the screening process, data abstraction, and quality assessment (MINORS). PRISMA guidelines were followed, and this review was registered with PROSPERO (#125811).
RESULTS: Ten studies were included, 9 case series and 1 cohort study, with a total of 211 hand joint denervation in 192 patients. In all studies, joint denervation improved pain and hand function at follow-up (mean = 36.8; range = 3–90 months). Pooled analysis of 3 studies on the first carpometacarpal joint showed a statistically significant (P < 0.001) reduction in pain scores from baseline (mean = 6.61 ± 2.03) to postoperative (mean = 1.69 ± 1.27). The combined complication rate was 18.8% (n = 36/192), and the most commonly reported complication was neuropathic pain or unintended sensory loss (8.8%; n = 17/192).
CONCLUSIONS: The findings of this review suggest that denervation may be an effective and low morbidity procedure for the treatment of osteoarthritis in the joints of the hand. Denervation may serve as a useful tool in the hand surgeon’s armamentarium, particularly for patients failing nonoperative management and looking to pursue less invasive surgical management. Further prospective comparative studies are required to develop a more comprehensive understanding of the outcomes of denervation, especially in comparison to more conventional procedures of osteotomy, arthroplasty, and arthrodesis.