Cochrane: surgery for thumb CMC OA

Surgery for thumb (trapeziometacarpal joint) osteoarthritis

Wajon A, Vinycomb T, Carr E, et al. The Cochrane database of systematic reviews 2015 · PMID 25702783 · doi:10.1002/14651858.cd004631.pub4

Systematic review / meta-analysisManagementHandCitation checked

Question: Is any surgical procedure for base of thumb osteoarthritis superior to the others?
Design: Cochrane systematic review and meta-analysis of randomised and quasi-randomised trials.
Patients: Adults undergoing surgery for trapeziometacarpal joint osteoarthritis.
Intervention: Trapeziectomy with or without LRTI or interposition, arthrodesis, joint replacement and other procedures
Comparison: Each other, particularly trapeziectomy alone
Primary outcome: Pain, function, global assessment and adverse events
Key result: No procedure showed clear superiority over another, including over trapeziectomy alone, for pain, function, quality of life or adverse events; most trials had unclear risk of bias.
Limitations: Small, heterogeneous trials of uncertain quality; few trials of newer joint replacements.
Impact on practice: Underpins simple trapeziectomy as the reference procedure for end-stage base of thumb OA after failed splinting, analgesia and injection, with arthroplasty still under evaluation.