Comment on: “Thumb carpometacarpal joint osteoarthritis: Is there a role for denervation? A systematic review”

Stögner, Viola-Antonia; Krezdorn, Nicco; Vogt, Peter M.

doi:10.1016/j.bjps.2020.11.016

Cited by 3 publications

(8 citation statements)

References 5 publications

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“…Common complications are wound infection and hypoesthesia. In the comment of Stögner et al, 11 complications were not applicable. Spielman et al 10 did not mention the complication rate.…”

Section: Resultsmentioning

confidence: 97%

“…Eight studies were performed in Europe, 3 in the United States, and 1 in Canada. It was not stated where the comment by Stögner et al 11 was written. Salibi et al 17 compared a denervation technique to a trapeziectomy.…”

Section: Resultsmentioning

confidence: 99%

“…One study was a prospective cohort study and scored 7 out of 11 points. 11 Confounding factors were identified, which benefits internal validity. Nevertheless, no methods to deal with these confounding factors were mentioned.…”

Section: Resultsmentioning

confidence: 99%

“…Complications with corresponding complication rates are shown in Table 1 . Three studies 11 17 19 defined persistent pain (treatment failure) as a complication. Common complications are wound infection and hypoesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…The baseline patient characteristics from all studies, except for the opinion article by Stögner et al, 11 were extracted (see Table 1 ). These consist of the number of patients and affected thumbs, percentage of female patients, age, follow-up, severity of OA, complication rate, and complications.…”

Section: Methodsmentioning

confidence: 99%

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Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction

Berkhout,

Bosch,

Ritt

2023

J Wrist Surg

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Background The treatment of patients with osteoarthritis of the first carpometacarpal joint (CMC-I) aims at pain reduction to improve hand function and quality of life. The CMC-I denervation procedure is relatively new and seems appealing, as it is minimally invasive and has few or no disadvantages. To date, however, little research has been done on the results of a CMC-I denervation. The aim of this study was to investigate whether denervation provides pain reduction in patients with early CMC-I osteoarthritis. Methods A literature search was done using PubMed. Studies were excluded if access to full text was not available, if the articles were written in other languages than Dutch or English, and if preoperative testing, follow-up testing, or reporting were incomplete. Studies were included if patients were older than 18 years, had primary CMC-I osteoarthritis with no other wrist pathology, and had received conservative treatment without sustained benefit. The Critical Appraisal Tools of the Joanna Briggs Institute were used for critical appraisal.Clinical data was gathered retrospectively from the medical records to identify patients who underwent CMC-I denervation in The Hand Clinic, Amsterdam. The data of 20 patients were analyzed. Pre- and postoperative visual analog scale (VAS) scores on pain, patient satisfaction, and complications were evaluated. Patients older than 18 years with primary CMC-I osteoarthritis stage I and II and no other wrist pathology, in whom conservative treatment failed were included in the study. Patients with CMC-I osteoarthritis stage III and IV were excluded. Results All 17 search results were screened for full text access, after which 6 case series, 4 systematic reviews, 1 cohort study, 1 comment, and 1 scoping review was included. All but one study showed pain reduction after surgery. In half of the studies, this difference was statistically significant. The average patient satisfaction in these studies was 84.1% and the complication rate was 13.4%.A total of 20 patients were included between 2019 and 2022, with a mean preoperative VAS for pain at rest of 48.2 ± 29.9. After surgery, this decreased to 35.8 ± 34.1. This difference was not statistically significant. The mean VAS for pain during use before denervation was 79 ± 18.4 and this decreased to 49.8 ± 34.2 postoperatively. This difference did appear to be statistically significant. The average patient satisfaction was 60%, and the complication rate was 10%. Conclusion This study provides a literature overview and a pilot study on pain reduction, patient satisfaction, and complications after denervation of the CMC-I joint in patients with early osteoarthritis. Our retrospective case series roughly mirrored the average results found in the literature. There was a statistically significant decrease in pain during use postoperatively. There was no statistically significant difference in pain at rest before and after surgery. The complications were mild and the complication rate was low; however, the average patient satisfaction rate was lower as compared to that reported in the literature.

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“…Common complications are wound infection and hypoesthesia. In the comment of Stögner et al, 11 complications were not applicable. Spielman et al 10 did not mention the complication rate.…”

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction

Berkhout,

Bosch,

Ritt

2023

J Wrist Surg

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Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients

Rath¹,

Haerle²,

Stollberg³

et al. 2023

Hand Surgery and Rehabilitation

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Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review

Meulen

Stadt²,

Claassen³

et al. 2023

RMD Open

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ObjectiveSurgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a research agenda.MethodsA systematic literature search was performed up to September 2022. Two investigators independently identified studies that reported on denervation for OA of the proximal interphalangeal, distal interphalangeal, metacarpophalangeal or carpometacarpal joints. Quality of studies was assessed and study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted.ResultsOf 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. Sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. One non-randomised clinical trial reported no difference in outcome when comparing denervation of the first carpometacarpal (CMC I) joint to trapeziectomy. Adverse events were frequent, with sensory abnormalities occurring the most, followed by the need for revision surgery. All studies had significant risk of bias.ConclusionSurgical denervation for pain in hand OA shows some promise, but the available evidence does not allow any conclusions of efficacy and higher-quality research is needed. Techniques should be harmonised and more data regarding how denervation compares to current usual care, other denervation methods or placebo in terms of outcomes and adverse events are needed.

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Comment on: “Thumb carpometacarpal joint osteoarthritis: Is there a role for denervation? A systematic review”

Cited by 3 publications

References 5 publications

Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction

Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction

Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients

Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review

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