Abstract
PURPOSE: Our aim was to compare the efficacy and safety of the available surgical interventions for trapeziometacarpal joint (TMCJ) arthritis. METHODS: We conducted a systematic review and network meta-analysis of randomized studies comparing surgical interventions for TMCJ arthritis. Our primary outcome was patient-reported pain, and secondary outcomes were patient-reported functional disability, key pinch strength, and complications. Mean differences (MD) and standardized mean differences (SMD) were calculated for continuous outcomes and odds ratios (OR) for dichotomous outcomes, all with 95% confidence intervals. RESULTS: Twenty-one randomized studies were included. In pairwise meta-analyses, when simple trapeziectomy was compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI), all pain, functional disability, and key pinch strength were similar (pain visual analogue scale, MD 0.22 points [-0.66 to 0.21]; functional disability, SMD 0.17 [-0.06 to 0.41]; key pinch strength, MD 0.07 kg [-0.22 to 036], P = .64). Compared with trapeziectomy (with or without LRTI), total joint arthroplasty provided similar short-term pain relief (MD 0.20 points [-0.10 to 0.50], moderate certainty of evidence), statistically greater improvement in short-term functional disability (disabilities of the arm, shoulder, and hand), and key pinch strength (function disabilities of the arm, shoulder, and hand, MD 5.24 points [0.72-9.75], low certainty of evidence; key pinch strength, MD 0.92 kg [0.63,-1.21], and moderate certainty of evidence]). Only the difference in key pinch strength exceeded clinical significance. In network meta-analyses, total joint arthroplasty ranked first for all short-term pain, function, and key pinch strength; however, its superiority over other treatments was only significant for key pinch strength. Short-term complications between simple trapeziectomy and trapeziectomy with LRTI, and between trapeziectomy and total joint arthroplasty were similar; however, longer-term data were not available. CONCLUSIONS: Total joint arthroplasty appears to be at least as effective as trapeziectomy for pain relief and functional disability and may be superior for key pinch strength in the short-term. Until long-term efficacy, complication, and survivorship data arising from high-quality comparative studies become available, its widespread use cannot be recommended. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.