Surgical management of thumb carpometacarpal arthritis: A systematic review of trapeziectomy, suspension, and arthroplasty procedures over the last 20 years.

BACKGROUND

Thumb carpometacarpal joint osteoarthritis (CMC OA) is common, affecting mainly individuals in their 50s and 60s. Operative options are numerous, including ligament reconstruction and tendon interposition (LRTI), suspensionplasty, arthroplasty, or arthrodesis. This review sought to summarize and compare these surgical treatments for thumb CMC OA.

METHODS

Systematic review and meta-analysis were performed per PRISMA guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on thumb CMC OA since 2005. Patients under 18 years of age, revision surgery, concomitant non-thumb surgeries, and studies with less than 12-month follow-up were excluded. Demographics, strength, outcome scores, and complications were evaluated.

RESULTS

177 articles were included, evaluating 13,332 thumbs, average age 61 years and 81% female. Of included thumbs, 38% received CMC arthroplasty (5088 thumbs), 36% LRTI (4751 thumbs), 15% suspensionplasty (1932 thumbs), 6.5% CMC arthrodesis (870 thumbs), and 5.2% trapeziectomy alone (691 thumbs). Postoperative grip strength, DASH, and VAS pain score were similar across included techniques. QuickDASH was significantly lower in suspensionplasty and Kapandji score was significantly higher in trapeziectomy alone. CMC arthroplasty demonstrated a revision rate of 6% compared to 4% in CMC arthrodesis and 1% in trapeziectomy, suspensionplasty, and LRTI each. Fastest return to work was 8 weeks for trapeziectomy alone.

CONCLUSIONS

Thumb CMC OA is a common problem affecting an aging population. Multiple operative options exist and are described, with all demonstrating reasonable outcomes. While complication rates are relatively low across modalities, CMC arthroplasty and arthrodesis may present with a different complication profile compared to other treatments. Although, available literature is mostly observational and heterogenous, and newer CMC arthroplasty are being approved.

LEVEL OF EVIDENCE: IV.