Do Preoperative Intra-Articular Steroid Injections Affect the Choice of Surgical Procedures for Thumb Carpometacarpal Osteoarthritis?

PURPOSE: This study investigated the influence of preoperative intra-articular steroid injections on surgical outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty and arthrodesis and aimed to determine whether preoperative steroid injections affect the choice of surgical procedures for treating painful thumb carpometacarpal osteoarthritis.

METHODS

We analyzed 49 and 51 thumbs treated with LRTI arthroplasty and arthrodesis, respectively. Preoperative intra-articular steroid injections were used for 12 and 15 thumbs in the LRTI and arthrodesis groups, respectively. Clinical outcomes were measured before surgery, 3 months after surgery, and at final follow-up using the Disabilities of the Arm, Shoulder, and Hand score, Hand20 questionnaire score, Kapandji score, and visual analog scale scores for pain, grip strength, and pinch strength. In the LRTI group, the trapezial space height and ratio were evaluated. In the arthrodesis group, the bone union rate and time to union were assessed. Radiological and clinical outcomes of both groups based on the use of steroid injections were compared at each time point. Chronological changes were also analyzed.

RESULTS

Intra-articular steroid injections did not affect radiological outcomes, including the trapezial space height and ratio in the LRTI group and bone union in the arthrodesis group. Significant differences in clinical outcomes of both groups based on the use of steroid injections were not observed during follow-up. Chronological analyses revealed that grip strength and pinch strength in the steroid injection subgroup were less improved than those in the no steroid injection subgroup of the LRTI group. Conversely, no significant differences in clinical outcome improvements were observed in these subgroups of the arthrodesis group.

CONCLUSIONS

Intra-articular steroid injections did not affect radiological and clinical outcomes of LRTI arthroplasty and arthrodesis. Both procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.