Study characteristics
Researchers from the Cochrane Collaboration examined the evidence for surgical treatment for osteoarthritis of the thumb. After searching for all relevant studies up to 8 August 2013, we included 11 studies (670 participants). Most participants were women with osteoarthritis who had inadequate relief with conservative measures, such as splinting, or oral analgesia such as paracetamol.
The most common technique used involved the removal of the trapezium bone at the base of the thumb (trapeziectomy) plus reconstruction of the ligament that holds the bones between the thumb and index finger together (ligament reconstruction) and filling the space left behind by the removed trapezium with spare tendon from the forearm to support the thumb (interpositional arthroplasty (IA); or commonly called 'trapeziectomy with LRTI'). Four studies (421 participants) compared this to the second most common procedure, trapeziectomy alone. Other studies compared trapeziectomy with LRTI to joint resurfacing (two studies, 113 people), arthrodesis (joint fusion; one study, 40 participants) or joint replacement (one study, 26 people). No studies included sham surgery as a comparison.
We chose trapeziectomy with LRTI versus trapeziectomy alone as our main comparison as these are the two most commonly performed procedures and were represented in the most studies (four studies).
Key results:
Trapeziectomy with LRTI versus trapeziectomy alone
Pain on a scale of 0 to 100 mm (lower scores mean reduced pain):
- People who underwent trapeziectomy with LRTI rated their pain to be 3 mm lower (10 mm lower to 4 mm higher) at three to 54 months of follow-up (3% absolute improvement) compared with people who had trapeziectomy alone;
- People who underwent trapeziectomy with LRTI rated their pain as 30 mm;
- People who underwent trapeziectomy alone rated their pain as 26 mm.
Physical function (0 to 100 point score, lower means less disability):
- People who underwent trapeziectomy with LRTI rated their disability as 0.03 points higher (0.83 points lower to 0.88 points higher) at seven to 97 months follow-up compared to people who had trapeziectomy alone;
- People who underwent trapeziectomy with LRTI rated their disability as 31 points;
- People who underwent trapeziectomy alone also rated their disability as 31 points.
Side effects
- Nine more people out of 100 (0 to 29 more people) who had trapeziectomy with LRTI experienced side effects (9% absolute increase in adverse events), compared with people who had trapeziectomy alone;
- 19 out of 100 people who had trapeziectomy with LRTI had an adverse event;
- 10 out of 100 who underwent trapeziectomy alone experienced an adverse event.
Single studies reported comparison between less commonly performed techniques that are reported in the main article.
Quality of the evidence
There is low-quality evidence that in people with thumb osteoarthritis, trapeziectomy with LRTI may not improve pain or function, or have less side effects than trapeziectomy alone. There was insufficient moderate or high quality evidence to assess if trapeziectomy with LRTI had additional benefit over trapeziectomy with ligament reconstruction, arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone.
Further research is likely to change the estimates of these results.
We are uncertain if any surgery has benefits compared to no surgery or sham surgery as no studies were found assessing this comparison. We have not assessed if surgery is better than other commonly used conservative therapies in this review.
Authors' conclusions:
We did not identify any
studies that compared surgery to sham surgery and we excluded studies
that compared surgery to non-operative treatments. We were unable to
demonstrate that any technique confers a benefit over another technique
in terms of pain and physical function. Furthermore, the included
studies were not of high enough quality to provide conclusive evidence
that the compared techniques provided equivalent outcomes.