Surgery for thumb (trapeziometacarpal joint) osteoarthritis
Abstract
Background
This is an update of a Cochrane Review first published in 2005. Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another.
Objectives
To compare the effect of different surgical techniques in reducing pain and improving physical function, patient global assessment, range of motion and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, to investigate whether there was any improvement or deterioration in outcomes between the 12‐month review and five year follow up.
Search methods
We searched:(CENTRAL) (The Cochrane Library 2008, issue 1), MEDLINE (1950 to Dec 2008), CINAHL (1982 to Dec 2008), AMED (1985 to Dec 2008) and EMBASE (1974 to Dec 2008), and performed handsearching of conference proceedings and reference lists from reviews and papers.
Selection criteria
Randomised or quasi‐randomised trials where the intervention was surgery and pain, physical function, patient global assessment, range of motion or strength was measured as an outcome.
Data collection and analysis
Two review authors independently selected studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse effects. We contacted trial authors for missing information.
Main results
We included nine studies involving 477 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty, Artelon joint resurfacing, arthrodesis and joint replacement). Studies reported results of a mixed group of participants with Stage II‐IV osteoarthritis, with a range of improvement for pain and physical function. The majority of studies included in this review had an unclear risk of bias which raises some doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment or range of motion. Of participants who underwent trapeziectomy with ligament reconstruction and tendon interposition, 22% had adverse effects (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1)) compared to 10% who underwent trapeziectomy. Trapeziectomy with ligament reconstruction and tendon interposition is therefore associated with 12% more adverse effects (RR = 2.21, 95% CI 1.18 to 4.15).
Authors' conclusions
Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.
PICOs
Plain language summary
Surgery for osteoarthritis of the thumb
This summary of a Cochrane review presents what we know from research about the effect of surgery on osteoarthritis of the thumb.
The review shows that in people with osteoarthritis, trapeziectomy with ligament reconstruction and tendon interposition:
‐ may not improve your pain compared with trapeziectomy;
‐ may improve your physical function compared with trapeziectomy;
‐ will probably lead to more side effects.
We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects.
What is osteoarthritis of the thumb and why surgery?
Osteoarthritis is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. Osteoarthritis (OA) at the base of the thumb (or trapeziometacarpal joint) causes pain, stiffness and weakness in the thumb. This can affect how well the thumb moves, how strong a person's grip is, and how well a person can do routine things at home or at work. There are many types of surgery for the base of the thumb. The simplest surgery is 'trapeziectomy'. Other surgeries use this simple approach but will also work on ligaments and tendons at the thumb or replace the thumb joint. For example, trapeziectomy with ligament reconstruction and tendon interposition takes this approach.
Best estimate of what happens to people with osteoarthritis who have surgery:
Pain
‐ People who had trapeziectomy with ligament reconstruction and tendon interposition rated their pain to be 3 mm (millimetres) better after this surgery compared to trapeziectomy (3% absolute improvement), although this difference could have happened by chance.
‐ People who had trapeziectomy rated their pain to be between 16 and 37 mm on a scale of 0 to 100 mm after the surgery.
‐ People who had trapeziectomy with ligament reconstruction and tendon interposition rated their pain to be 3 mm better after this surgery compared to trapeziectomy, although this difference could have happened by chance.
Physical function
‐ People who had trapeziectomy rated their ability to move normally to be between 30 and 33 mm on a scale of 0 to 100 mm after the surgery.
‐ People who had trapeziectomy with ligament reconstruction and tendon interposition rated their ability to function normally to be 3 mm worse after this surgery compared to trapeziectomy, although this difference could have happened by chance.
Side effects
‐ 12 more people out of 100 had side effects like scar tenderness, or tendon damage (a tendon is tissue that connects the muscle to the bone) following trapeziectomy with ligament reconstruction and tendon interposition (12% absolute difference).
‐ 11 people out of 100 who had trapeziectomy had side effects.
‐ 23 people out of 100 who had trapeziectomy with ligament reconstruction and tendon interposition had side effects.
