Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus Trapeziectomy (T), outcome: 1.1 Pain ‐ 100 mm VAS (post‐intervention).
Figures and Tables -
Figure 3

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus Trapeziectomy (T), outcome: 1.1 Pain ‐ 100 mm VAS (post‐intervention).

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.2 Pain ‐ number of participants with resting pain.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.2 Pain ‐ number of participants with resting pain.

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.11 Adverse events ‐ number of participants with adverse events (post‐intervention).
Figures and Tables -
Figure 5

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.11 Adverse events ‐ number of participants with adverse events (post‐intervention).

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.9 Strength ‐ lateral (key) pinch strength (kg).
Figures and Tables -
Figure 6

Forest plot of comparison: 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), outcome: 1.9 Strength ‐ lateral (key) pinch strength (kg).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 1 Pain ‐ 100 mm VAS.
Figures and Tables -
Analysis 1.1

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 1 Pain ‐ 100 mm VAS.

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 2 Pain ‐ number of participants with resting pain.
Figures and Tables -
Analysis 1.2

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 2 Pain ‐ number of participants with resting pain.

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 3 Physical function ‐ 0‐100 with '0' = no disability.
Figures and Tables -
Analysis 1.3

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 3 Physical function ‐ 0‐100 with '0' = no disability.

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 4 Adverse events ‐ number of participants with adverse events.
Figures and Tables -
Analysis 1.4

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 4 Adverse events ‐ number of participants with adverse events.

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).
Figures and Tables -
Analysis 1.5

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 6 Range of motion ‐ palmar abduction (cm).
Figures and Tables -
Analysis 1.6

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 6 Range of motion ‐ palmar abduction (cm).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 7 Range of motion ‐ palmar abduction (degrees).
Figures and Tables -
Analysis 1.7

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 7 Range of motion ‐ palmar abduction (degrees).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 8 Strength ‐ tip pinch strength (kg).
Figures and Tables -
Analysis 1.8

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 8 Strength ‐ tip pinch strength (kg).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 9 Strength ‐ lateral (key) pinch strength (kg).
Figures and Tables -
Analysis 1.9

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 9 Strength ‐ lateral (key) pinch strength (kg).

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 10 Strength ‐ grip strength (kg).
Figures and Tables -
Analysis 1.10

Comparison 1 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T), Outcome 10 Strength ‐ grip strength (kg).

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 1 Pain ‐ number of participants with frequent or constant pain.
Figures and Tables -
Analysis 2.1

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 1 Pain ‐ number of participants with frequent or constant pain.

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 2 Physical function ‐ number of participants with moderate difficulty with daily function.
Figures and Tables -
Analysis 2.2

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 2 Physical function ‐ number of participants with moderate difficulty with daily function.

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 3 Physical function ‐ Buck Gramcko score (number of participants with good‐excellent total score).
Figures and Tables -
Analysis 2.3

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 3 Physical function ‐ Buck Gramcko score (number of participants with good‐excellent total score).

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 4 Adverse events ‐ number of participants with adverse events.
Figures and Tables -
Analysis 2.4

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 4 Adverse events ‐ number of participants with adverse events.

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).
Figures and Tables -
Analysis 2.5

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 6 Range of motion ‐ palmar abduction (degrees).
Figures and Tables -
Analysis 2.6

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 6 Range of motion ‐ palmar abduction (degrees).

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 7 Strength ‐ lateral (key) pinch strength (kg).
Figures and Tables -
Analysis 2.7

Comparison 2 Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR), Outcome 7 Strength ‐ lateral (key) pinch strength (kg).

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 1 Pain ‐ 100 mm VAS during key pinch.
Figures and Tables -
Analysis 4.1

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 1 Pain ‐ 100 mm VAS during key pinch.

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 2 Pain ‐ 100 mm VAS during tripod pinch.
Figures and Tables -
Analysis 4.2

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 2 Pain ‐ 100 mm VAS during tripod pinch.

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 3 Adverse events ‐ mild to moderate swelling.
Figures and Tables -
Analysis 4.3

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 3 Adverse events ‐ mild to moderate swelling.

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 4 Treatment failure ‐ reoperation due to pain.
Figures and Tables -
Analysis 4.4

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 4 Treatment failure ‐ reoperation due to pain.

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 5 Range of motion ‐ palmar abduction (degrees).
Figures and Tables -
Analysis 4.5

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 5 Range of motion ‐ palmar abduction (degrees).

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 6 Strength ‐ lateral (key) pinch strength (kg).
Figures and Tables -
Analysis 4.6

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 6 Strength ‐ lateral (key) pinch strength (kg).

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 7 Strength ‐ pinch (tripod) strength (kg).
Figures and Tables -
Analysis 4.7

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 7 Strength ‐ pinch (tripod) strength (kg).

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 8 Strength ‐ grip strength (kg).
Figures and Tables -
Analysis 4.8

Comparison 4 Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant, Outcome 8 Strength ‐ grip strength (kg).

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 1 Pain ‐ 100 mm VAS.
Figures and Tables -
Analysis 5.1

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 1 Pain ‐ 100 mm VAS.

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 2 Adverse events ‐ number of participants with adverse events.
Figures and Tables -
Analysis 5.2

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 2 Adverse events ‐ number of participants with adverse events.

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 3 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).
Figures and Tables -
Analysis 5.3

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 3 Trapeziometacarpal joint imaging ‐ SMD at rest (mm).

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 4 Range of motion ‐ palmar abduction (degrees).
Figures and Tables -
Analysis 5.4

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 4 Range of motion ‐ palmar abduction (degrees).

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 5 Strength ‐ lateral (key) pinch strength (kp/cm2).
Figures and Tables -
Analysis 5.5

Comparison 5 Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson), Outcome 5 Strength ‐ lateral (key) pinch strength (kp/cm2).

Summary of findings for the main comparison. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T)

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)
Comparison: Trapeziectomy (T)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Trapeziectomy (T)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)

Pain
100mm VAS . Scale from: 0 to 100.
Follow‐up: 3 to 54 months

The mean pain in the control groups was
26 mm

The mean pain in the intervention groups was
2.8 lower
(9.8 lower to 4.2 higher)

162
(3 studies)

⊕⊕⊝⊝
low1,2,3,4

Absolute change ‐3% (‐10% to 4%); Relative change ‐4% (‐13% to 6%)5.

Physical function
DASH Score. Scale from: 0 to 100.
Follow‐up: 7 to 97 months

The mean physical function in the control groups was
31 points

The mean physical function in the intervention groups was
0.01 standard deviations higher
(0.30 lower to 0.32 higher)

This translates to an absolute mean increase of 0.03 (‐0.83 to 0.88) points compared to control using a 0 to 100 point scale7

211
(3 studies)

⊕⊕⊝⊝
low1,2,4,6

SMD 0.01 (‐0.30 to 0.32); Absolute change 0.03% (‐0.83% to 0.88%); Relative change 0.05% (‐1.56% to 1.66%)7.

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
Complications reported
Follow‐up: 7 to 54 months

Moderate

RR 1.81
(0.96 to 3.73)

328
(4 studies)

⊕⊕⊝⊝
low1,3,4,6,8

Absolute change of 5% (‐1% to 11%)<BR/>Relative change 89% (‐4% to 273%)

10 per 100

19 per 100
(10 to 39)

Treatment failure ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Trapeziometacarpal joint imaging
Scapho‐metacarpal distance
Follow‐up: 7 to 29 months

The mean trapeziometacarpal joint imaging in the control groups was
2.3 mm

The mean trapeziometacarpal joint imaging in the intervention groups was
0.1 lower
(0.81 lower to 0.61 higher)

42
(1 study)

⊕⊕⊝⊝
low1,4

Absolute and relative change cannot be calculated9.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Belcher 2000: Unclear performance bias; unclear detection bias; unclear attrition bias; unclear reporting bias.
2De Smet 2004: Unclear selection bias; unclear performance bias; unclear detection bias; unclear attrition bias; unclear reporting bias.
3Field 2007: Unclear selection bias; unclear performance bias; unclear detection bias; unclear reporting bias.
4 Less than 300 total participants (imprecision).
5 Relative change calculated using the mean from control group in Field 2007 (mean 76 mm).
6Salem 2012: Unclear selection bias; unclear performance bias; high risk of selection bias; unclear reporting bias.
7 Absolute and relative change calculated using the mean and SD from the control group in Salem 2012 (DASH score, mean 53 points; SD 2.75 points).
8Gangopadhyay 2012: Unclear performance bias; unclear reporting bias.
9 Absolute change cannot be calculated as there is no scale for trapeziometacarpal joint space imaging. Relative change cannot be calculated as there is no baseline mean in any control groups as this space is created during the surgery.

Figures and Tables -
Summary of findings for the main comparison. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T)
Summary of findings 2. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR)

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)
Comparison: Trapeziectomy and ligament reconstruction (T and LR)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Trapeziectomy and ligament reconstruction (T and LR)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)

Pain ‐ not measured

See comment

See comment

Not estimable

See comment

Participant‐reported pain relief of 50% or greater or VAS pain scores not reported in any study.

Physical function
Buck‐Gramcko score: Number with good‐excellent total score
Follow‐up: 15 to 120 months

Moderate

RR 0.82
(0.63 to 1.06)

31
(1 study)

⊕⊕⊝⊝
low1,2

Absolute change of ‐19% (‐40% to 2%); Relative decrease 18% (‐35% to 27%).

100 per 100

82 per 100
(63 to 100)

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
Complications reported
Follow‐up: 15 to 120 months

Moderate

RR 1.41
(0.27 to 7.28)

31
(1 study)

⊕⊕⊝⊝
low1,2

Absolute change 5% (‐20% to 31%); Relative change 41% (‐73% to 628%).

13 per 100

19 per 100
(4 to 97)

Treatment failure ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Trapeziometacarpal joint imaging
Scapho‐metacarpal distance
Follow‐up: mean 23 months

The mean trapeziometacarpal joint imaging in the control groups was
5.2 mm

The mean trapeziometacarpal joint imaging in the intervention groups was
0.7 lower
(1.9 lower to 0.5 higher)

20
(1 study)

⊕⊕⊝⊝
low2,3

Absolute and relative change cannot be calculated4.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Kriegs‐Au 2004: Unclear selection bias; unclear performance bias; unclear detection bias, unclear reporting bias.
2 Less than 300 total participants (imprecision).
3Gerwin 1997: Unclear selection bias; unclear performance bias; unclear detection bias; unclear attrition bias; unclear reporting bias.
4 Absolute change cannot be calculated as there is no scale for trapeziometacarpal joint space imaging. Relative change cannot be calculated as there is no baseline mean in any control groups as this space is created during the surgery.

Figures and Tables -
Summary of findings 2. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR)
Summary of findings 3. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and interpositional arthroplasty (T and IA)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and interpositional arthroplasty (T and IA)

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)
Comparison: Trapeziectomy and interpositional arthroplasty (T and IA)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Trapeziectomy and interpositional arthroplasty (T and IA)

Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI)

Pain ‐ not measured

See comment

See comment

Not estimable

See comment

Participant‐reported pain relief of 50% or greater or VAS pain scores not reported in any study.

Physical function ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
complications reported
Follow‐up: 5 to 18 years

Moderate

RR 1.36
(0.48 to 3.88)

100
(1 study)

⊕⊕⊕⊝
moderate1,2

Absolute change of 4% (‐9% to 17%); Relative change 36% (‐52% to 288%).

24 per 100

32 per 100
(11 to 92)

Treatment failure ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Trapeziometacarpal joint imaging ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Gangopadhyay 2012: Unclear performance bias; unclear reporting bias.
2 Less than 300 total participants (imprecision).

Figures and Tables -
Summary of findings 3. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and interpositional arthroplasty (T and IA)
Summary of findings 4. Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon joint resurfacing

Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon joint resurfacing

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with interpositional arthroplasty (IA)
Comparison: Artelon joint resurfacing

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Artelon joint resurfacing

Trapeziectomy with interpositional arthroplasty (IA)

Pain
100mm VAS. Scale from: 1 to 100.
Follow‐up: 3 years

The mean pain in the control groups was
21.2 mm

The mean pain in the intervention groups was
3.2 lower
(23.8 lower to 17.3 higher)

77
(2 studies1)

⊕⊝⊝⊝
very low2,3

Absolute change ‐3% (‐24% to 17%); Relative change ‐7% (‐53% to 38%).

Physical function ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
Mild to moderate swelling
Follow‐up: 1 year

33 per 100

3 per 100
(0 to 20)

RR 0.09
(0.01 to 0.61)

98
(1 study)

⊕⊝⊝⊝
very low3,4

Absolute change ‐30% (‐18% to ‐43%); Relative change ‐81% (‐99% to ‐49%); Number needed to benefit 4 (4 to 7).

Treatment failure
Reoperation due to pain
Follow‐up: 1 year

10 per 100

1 per 100
(0 to 22)

RR 0.14
(0.01 to 2.36)

98
(1 study)

⊕⊝⊝⊝
very low3,4

Absolute change ‐10% (‐1% to ‐18%); Relative change ‐86% (‐99% to ‐136%).

Trapeziometacarpal joint imaging ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Nilsson 2005: Controlled, prospective pilot study.
2Nilsson 2005: High risk selection bias; unclear performance bias; unclear detection bias; high risk reporting bias.
3 Less than 300 total participants (imprecision).
4Nilsson 2010: Unclear selection bias; unclear performance bias; unclear detection bias; high risk attrition bias; unclear reporting bias.

Figures and Tables -
Summary of findings 4. Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon joint resurfacing
Summary of findings 5. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziometacarpal joint replacement (Swanson)

Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziometacarpal joint replacement (Swanson)

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with interpositional arthroplasty (T and IA)
Comparison: Trapeziometacarpal joint replacement (Swanson)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Trapeziometacarpal joint replacement (Swanson)

Trapeziectomy with interpositional arthroplasty (T and IA)

Pain
100mm VAS. Scale from: 0 to 100.
Follow‐up: 22 to 66 months

The mean pain in the control groups was
9.0 mm

The mean pain in the intervention groups was
5.0 higher
(7.4 lower to 17.4 higher)

26
(1 study)

⊕⊕⊝⊝
low1,2

Absolute change 5% (‐7.4% to 17%); Relative change 8% (‐12% to 27%).

Physical function ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
Complications reported
Follow‐up: 22 to 66 months

Moderate

RR 0.2
(0.01 to 3.8)

26
(1 study)

⊕⊕⊝⊝
low1,2

Absolute change ‐15% (‐82% to 7%); Relative change ‐80% (‐99% to 280%).

15 per 100

3 per 100
(0 to 59)

Treatment failure ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Trapeziometacarpal joint imaging ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Tagil 2002: Unclear selection bias; unclear performance bias; high risk detection bias; unclear reporting bias.
2 Less than 300 total participants (imprecision).

Figures and Tables -
Summary of findings 5. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziometacarpal joint replacement (Swanson)
Summary of findings 6. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziectomy (T)

Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziectomy (T)

Patient or population: Patients with thumb (trapeziometacarpal joint) osteoarthritis
Settings: Hospital
Intervention: Trapeziectomy with interpositional arthroplasty (T and IA)
Comparison: Trapeziectomy (T)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Trapeziectomy (T)

Trapeziectomy with interpositional arthroplasty (T and IA)

Pain ‐ not measured

See comment

See comment

Not estimable

See comment

Participant‐reported pain relief of 50% or greater or VAS pain scores not reported in any study.

Physical function ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Quality of life ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Global assessment ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Adverse events
Complications reported
Follow‐up: 5 to 18 years

Moderate

RR 1.44
(0.41 to 5.05)

99
(1 study)

⊕⊕⊕⊝
moderate1,2

Absolute change 3% (‐8% to 15%); Relative change 44% (‐59% to 405%).

14 per 100

21 per 100
(6 to 73)

Treatment failure ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

Trapeziometacarpal joint imaging ‐ not measured

See comment

See comment

Not estimable

See comment

Not reported in any study.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Gangopadhyay 2012: Unclear performance bias; unclear reporting bias.
2 Less than 300 total participants (imprecision).

Figures and Tables -
Summary of findings 6. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziectomy (T)
Table 1. Adverse events of trapeziectomy and LRTI versus trapeziectomy

Study

Group

Tendon rupture/adhesion

Scar tenderness or infection

Recurrent pain

Sensory change

Cut PCMN

Neuroma

Instability

De Quervain's Disease

CRPS (type 1)

Belcher 2000

Trapeziectomy (n = 19)

1

1

Trapeziectomy and LRTI (n = 23)

1

2

1

1

1

De Smet 2004

Trapeziectomy (n = 21)

1

Trapeziectomy and LRTI (n = 34)

Field 2007

Trapeziectomy (n = 32)

2

1

1

Trapeziectomy and LRTI (n = 33)

6

1

1

4

Gangopadhyay 2012

Trapeziectomy (n = 53)

2

2

Trapeziectomy and LRTI (n = 54)

2

2

2

2

Salem 2012

Trapeziectomy (n = 21)

3

1

1

Trapeziectomy and LRTI (n = 27)

1

1

4

1

Cut PCMN = cut palmar cutaneous branch of median nerve; CRPS = Complex Regional Pain Syndrome.

Figures and Tables -
Table 1. Adverse events of trapeziectomy and LRTI versus trapeziectomy
Table 2. Adverse effects of trapeziectomy and LRTI versus LR

Study

Group

CRPS (type 1)

Kriegs‐Au 2004

Trapeziectomy and LRTI (n = 16)

1

Trapeziectomy and LR (n = 15)

Cut PCMN = cut palmar cutaneous branch of median nerve; CRPS = Complex Regional Pain Syndrome.

Figures and Tables -
Table 2. Adverse effects of trapeziectomy and LRTI versus LR
Table 3. Adverse effects of trapeziectomy and LRTI versus IA

Study

Group

Tendon rupture/adhesion

Scar tenderness

Sensory change

Cut PCMN

Gangopadhyay 2012

Trapeziectomy and IA (n = 46)

1

2

2

Trapeziectomy and LRTI (n = 54)

2

2

2

2

Cut PCMN = cut palmar cutaneous branch of median nerve
CRPS = Complex Regional Pain Syndrome

Figures and Tables -
Table 3. Adverse effects of trapeziectomy and LRTI versus IA
Table 4. Adverse events of trapeziectomy and IA versus Artelon implant

Study

Group

Mild to moderate swelling

Re‐operation due to pain

Nilsson 2010

Trapeziectomy and IA (n = 35)

1

1

Artelon implant (n = 63)

6

Figures and Tables -
Table 4. Adverse events of trapeziectomy and IA versus Artelon implant
Table 5. Adverse events of trapeziectomy and LRTI versus Swanson joint replacement

Study

Group

Instability

CRPS (type 1)

Tagil 2002

Swanson (n = 13)

2

Trapeziectomy and IA (n = 13)

Cut PCMN = cut palmar cutaneous branch of median nerve
CRPS = Complex Regional Pain Syndrome

Figures and Tables -
Table 5. Adverse events of trapeziectomy and LRTI versus Swanson joint replacement
Table 6. Adverse events of trapeziectomy and IA versus trapeziectomy

Study

Group

Tendon rupture/adhesion

Sensory change

Cut PCMN

Gangopadhyay 2012

Trapeziectomy (n = 53)

2

2

Trapeziectomy and IA (n = 46)

1

2

2

Cut PCMN = cut palmar cutaneous branch of median nerve; CRPS = Complex Regional Pain Syndrome.

Figures and Tables -
Table 6. Adverse events of trapeziectomy and IA versus trapeziectomy
Comparison 1. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ 100 mm VAS Show forest plot

3

162

Mean Difference (IV, Random, 95% CI)

‐2.80 [‐9.82, 4.21]

2 Pain ‐ number of participants with resting pain Show forest plot

2

224

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.31, 4.54]

3 Physical function ‐ 0‐100 with '0' = no disability Show forest plot

3

211

Std. Mean Difference (IV, Random, 95% CI)

0.01 [‐0.30, 0.32]

4 Adverse events ‐ number of participants with adverse events Show forest plot

4

328

Risk Ratio (M‐H, Random, 95% CI)

1.89 [0.96, 3.73]

5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6 Range of motion ‐ palmar abduction (cm) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

7 Range of motion ‐ palmar abduction (degrees) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

8 Strength ‐ tip pinch strength (kg) Show forest plot

2

213

Mean Difference (IV, Random, 95% CI)

0.13 [‐0.26, 0.52]

9 Strength ‐ lateral (key) pinch strength (kg) Show forest plot

4

325

Mean Difference (IV, Random, 95% CI)

0.11 [‐0.18, 0.41]

10 Strength ‐ grip strength (kg) Show forest plot

2

213

Mean Difference (IV, Random, 95% CI)

0.59 [‐3.12, 4.29]

Figures and Tables -
Comparison 1. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy (T)
Comparison 2. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ number of participants with frequent or constant pain Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Physical function ‐ number of participants with moderate difficulty with daily function Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Physical function ‐ Buck Gramcko score (number of participants with good‐excellent total score) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Adverse events ‐ number of participants with adverse events Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Trapeziometacarpal joint imaging ‐ SMD at rest (mm) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6 Range of motion ‐ palmar abduction (degrees) Show forest plot

2

51

Mean Difference (IV, Random, 95% CI)

‐1.03 [‐7.81, 5.75]

7 Strength ‐ lateral (key) pinch strength (kg) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and ligament reconstruction (T and LR)
Comparison 3. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and interpositional arthroplasty (T and IA)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ number of participants with resting pain

0

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Adverse events ‐ Number of participants with adverse events

0

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3 Strength ‐ tip pinch strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Strength ‐ lateral (key) pinch strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Strength ‐ grip strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 3. Trapeziectomy with ligament reconstruction and tendon interposition (T and LRTI) versus trapeziectomy and interpositional arthroplasty (T and IA)
Comparison 4. Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ 100 mm VAS during key pinch Show forest plot

2

77

Mean Difference (IV, Random, 95% CI)

‐3.24 [‐23.77, 17.29]

2 Pain ‐ 100 mm VAS during tripod pinch Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Adverse events ‐ mild to moderate swelling Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Treatment failure ‐ reoperation due to pain Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Range of motion ‐ palmar abduction (degrees) Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

‐4.13 [‐11.16, 2.91]

6 Strength ‐ lateral (key) pinch strength (kg) Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

‐1.09 [‐2.40, 0.22]

7 Strength ‐ pinch (tripod) strength (kg) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

8 Strength ‐ grip strength (kg) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 4. Trapeziectomy with interpositional arthroplasty (T and IA) versus Artelon implant
Comparison 5. Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ 100 mm VAS Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 Adverse events ‐ number of participants with adverse events Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Trapeziometacarpal joint imaging ‐ SMD at rest (mm) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Range of motion ‐ palmar abduction (degrees) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Strength ‐ lateral (key) pinch strength (kp/cm2) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 5. Trapeziectomy with interpositional arthroplasty (T and IA) versus Trapeziometacarpal joint replacement (Swanson)
Comparison 6. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziectomy (T)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ number of participants with resting pain

0

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Adverse events ‐ number of participants with adverse events

0

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Strength ‐ lateral pinch strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Strength ‐ tip pinch strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Strength ‐ grip strength (kg)

0

Mean Difference (IV, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 6. Trapeziectomy with interpositional arthroplasty (T and IA) versus trapeziectomy (T)