Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications
Purpose: Thumb carpometacarpal osteoarthritis (CMC OA) is a common condition associated with functional limitations and pain. Surgical interventions for CMC OA include simple trapeziectomy, ligament reconstruction and tendon interposition, arthrodesis, and joint replacement. The aim of this review w...
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Elsevier
2025-05-01
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| Series: | Journal of Hand Surgery Global Online |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514125000180 |
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| author | Annora Ai-Wei Kumar, BBioMedSc Matthew Lawson-Smith, MBBCh BAO |
| author_facet | Annora Ai-Wei Kumar, BBioMedSc Matthew Lawson-Smith, MBBCh BAO |
| author_sort | Annora Ai-Wei Kumar, BBioMedSc |
| collection | DOAJ |
| description | Purpose: Thumb carpometacarpal osteoarthritis (CMC OA) is a common condition associated with functional limitations and pain. Surgical interventions for CMC OA include simple trapeziectomy, ligament reconstruction and tendon interposition, arthrodesis, and joint replacement. The aim of this review was to evaluate the comparative effectiveness of surgical techniques. Methods: A systematic review was performed, and the Medline, EMBASE, and SCOPUS databases were searched. Randomized controlled trials (RCTs) investigating the surgical management of CMC OA were included. The outcomes of interest were long-term pain reduction (visual analog scale), complications, and functional improvement (Disabilities of Arm, Shoulder and Hand questionnaire). Bayesian network meta-analyses were conducted, and longitudinal analysis of complication severity was performed using the Kruskal-Wallis H test. Results: There were 26 RCTs included, representing 19 surgical techniques and 1,193 hands. The average follow-up period was 29 months. In the analyses of pain, simple trapeziectomy ranked first, and trapeziectomy with button ranked last. Uncemented joint replacement ranked first in the analyses of function. Trapeziectomy alone demonstrated the most favorable results regarding avoidance of complications, and arthrodesis with plate and screw ranked last in the analysis of complications. Alternative surgical techniques were associated with a relative increase in complication severity across all time periods (χ2(2) = 22.92, 46.82, and 7.01 after 0–3, 3–12, and 12+ months; P < .001, <.001, and .03, respectively). Conclusions: Our findings demonstrate that simple trapeziectomy is effective at relieving the pain associated with CMC OA and minimizing postoperative complications, demonstrating a relative increase in both the number and severity of complications after alternative surgical techniques. Clinical relevance: Our review supports the use of simple trapeziectomy as the mainstay of surgical management of CMC OA, providing the foundation for research investigating metacarpal subsidence, trapeziometacarpal biomechanics, and implant dynamics in patients with CMC OA. |
| format | Article |
| id | doaj-art-2dd13a36f0fa4296b2458b0ca21cc3e3 |
| institution | DOAJ |
| issn | 2589-5141 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj-art-2dd13a36f0fa4296b2458b0ca21cc3e32025-08-20T03:13:12ZengElsevierJournal of Hand Surgery Global Online2589-51412025-05-017310070810.1016/j.jhsg.2025.02.001Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical ComplicationsAnnora Ai-Wei Kumar, BBioMedSc0Matthew Lawson-Smith, MBBCh BAO1Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia; Corresponding author: Annora Ai-Wei Kumar, The University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Australia.Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia; School of Medicine, The University of Notre Dame, Fremantle, WA, Australia; Department of Hand Surgery; Department of Orthopaedics, Fremantle Hospital, Fremantle, WA, AustraliaPurpose: Thumb carpometacarpal osteoarthritis (CMC OA) is a common condition associated with functional limitations and pain. Surgical interventions for CMC OA include simple trapeziectomy, ligament reconstruction and tendon interposition, arthrodesis, and joint replacement. The aim of this review was to evaluate the comparative effectiveness of surgical techniques. Methods: A systematic review was performed, and the Medline, EMBASE, and SCOPUS databases were searched. Randomized controlled trials (RCTs) investigating the surgical management of CMC OA were included. The outcomes of interest were long-term pain reduction (visual analog scale), complications, and functional improvement (Disabilities of Arm, Shoulder and Hand questionnaire). Bayesian network meta-analyses were conducted, and longitudinal analysis of complication severity was performed using the Kruskal-Wallis H test. Results: There were 26 RCTs included, representing 19 surgical techniques and 1,193 hands. The average follow-up period was 29 months. In the analyses of pain, simple trapeziectomy ranked first, and trapeziectomy with button ranked last. Uncemented joint replacement ranked first in the analyses of function. Trapeziectomy alone demonstrated the most favorable results regarding avoidance of complications, and arthrodesis with plate and screw ranked last in the analysis of complications. Alternative surgical techniques were associated with a relative increase in complication severity across all time periods (χ2(2) = 22.92, 46.82, and 7.01 after 0–3, 3–12, and 12+ months; P < .001, <.001, and .03, respectively). Conclusions: Our findings demonstrate that simple trapeziectomy is effective at relieving the pain associated with CMC OA and minimizing postoperative complications, demonstrating a relative increase in both the number and severity of complications after alternative surgical techniques. Clinical relevance: Our review supports the use of simple trapeziectomy as the mainstay of surgical management of CMC OA, providing the foundation for research investigating metacarpal subsidence, trapeziometacarpal biomechanics, and implant dynamics in patients with CMC OA.http://www.sciencedirect.com/science/article/pii/S2589514125000180Network meta-analysisOsteoarthritisPainTrapeziectomy |
| spellingShingle | Annora Ai-Wei Kumar, BBioMedSc Matthew Lawson-Smith, MBBCh BAO Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications Journal of Hand Surgery Global Online Network meta-analysis Osteoarthritis Pain Trapeziectomy |
| title | Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications |
| title_full | Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications |
| title_fullStr | Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications |
| title_full_unstemmed | Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications |
| title_short | Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review, Network Meta-analysis, and Longitudinal Analysis of Surgical Complications |
| title_sort | surgical management of thumb carpometacarpal osteoarthritis a systematic review network meta analysis and longitudinal analysis of surgical complications |
| topic | Network meta-analysis Osteoarthritis Pain Trapeziectomy |
| url | http://www.sciencedirect.com/science/article/pii/S2589514125000180 |
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