Total joint arthroplasty for thumb carpometacarpal joint osteoarthritis: a systematic review and meta-analysis of randomized controlled trials
DOI:
https://doi.org/10.2340/17453674.2024.40816Keywords:
Arthroplasty, Implants, Osteoarthrosis, ThumbAbstract
Background and purpose: Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies.
Patients and methods: We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis.
Results: We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA’s benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26–0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0–100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42–8.4).
Conclusion: Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
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e 2010; 36: 1-48. doi: 10.18637/jss.v036.i03. DOI: https://doi.org/10.18637/jss.v036.i03
Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evidence-Based Mental Health 2019; 22: 153-60. doi: 10.1136/ebmental-2019-300117. DOI: https://doi.org/10.1136/ebmental-2019-300117
R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2020.
RStudio Team. RStudio: Integrated development environment for R. Vienna: R Foundation for Statistical Computing; 2020.
Randall D J, Zhang Y, Li H, Hubbard J C, Kazmers N H. Establishing the minimal clinically important difference and substantial clinical benefit for the pain visual analog scale in a postoperative hand surgery population. J Hand Surg Am 2022; 47: 645-53. doi: 10.1016/j.jhsa.2022.03.009. DOI: https://doi.org/10.1016/j.jhsa.2022.03.009
Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44: 30-9. doi: 10.2519/jospt.2014.4893. DOI: https://doi.org/10.2519/jospt.2014.4893
Bohannon R W. Minimal clinically important difference for grip strength: a systematic review. J Phys Ther Sci 2019; 31: 75-8. doi: 10.1589/jpts.31.75. DOI: https://doi.org/10.1589/jpts.31.75
Villafañe J H, Valdes K, Bertozzi L, Negrini S. Minimal clinically important difference of grip and pinch strength in women with thumb carpometacarpal osteoarthritis when compared to healthy subjects. Rehabil Nurs 2017; 42: 139-45. doi: 10.1002/rnj.196. DOI: https://doi.org/10.1002/rnj.196
Raj S, Clay R, Ramji S, Shaunak R, Dadrewalla A, Sinha V, et al. Trapeziectomy versus joint replacement for first carpometacarpal (CMC 1) joint osteoarthritis: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2022; 32: 1001-21. doi: 10.1007/s00590-021-03070-5. DOI: https://doi.org/10.1007/s00590-021-03070-5
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 2021; 11: 272-8. doi: 10.1055/s-0041-1731818. DOI: https://doi.org/10.1055/s-0041-1731818
Froschauer S M, Holzbauer M, Hager D, Schnelzer R, Kwasny O, Duscher D. Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study. J Hand Surg Eur 2020; 45: 452-7. doi: 10.1177/1753193419873230. DOI: https://doi.org/10.1177/1753193419873230
Cebrian-Gomez R, Lizaur-Utrilla A, Sebastia-Forcada E, Lopez-Prats F A. Outcomes of cementless joint prosthesis versus tendon interposition for trapeziometacarpal osteoarthritis: a prospective study. J Hand Surg Eur 2019; 44: 151-8. doi: 10.1177/1753193418787151. DOI: https://doi.org/10.1177/1753193418787151
Herren D B, Fuchs N, Schindele S, Marks M. Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty. J Hand Surg Eur 2021; 46: 1101-7. doi: 10.1177/17531934211050559. DOI: https://doi.org/10.1177/17531934211050559
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Copyright (c) 2024 Rasmus Liukkonen, Venla-Linnea Karjalainen, Reetta Kvist, Matias Vaajala, Ville Ponkilainen, Teemu Karjalainen
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