Comparison of 2 Postoperative Therapy Regimens After Trapeziectomy Due to Osteoarthritis: A Randomized, Controlled Trial

Abstract

Purpose The main aim of the present study was to evaluate whether early mobilization after trapeziectomy in the first carpometacarpal joint is noninferior to a postoperative regimen comprising the use of a rigid orthosis and mobilization after 6 weeks, with regards to patient-reported activity performance and the effect of surgery in patients with first carpometacarpal osteoarthritis.Methods In this prospective, randomized, controlled noninferiority trial, participants were assessed at baseline (before group allocation) and at 3, 6, and 12 months after surgery. The primary outcomes were activity performance, measured using the Canadian Occupational Performance Measure (1e10, where 1 ¼ unable to perform), and the patient-reported effect of surgery on a 6-point scale ranging from "much worse" to "completely recovered." A change of 2.0 points in the Canadian Occupational Performance Measure was used as a noninferiority margin. Secondary outcomes included hand function (patient-reported in the Measure of Activity Performance of the Hand questionnaire), pain on a numeric rating scale, grip and pinch strengths, and joint mobility. We performed both intention-to-treat and per-protocol analyses. ResultsOf the 59 participants (88% women) with a mean age of 65 years, 55 (93%) completed all assessments. We found no differences between the groups in primary or secondary outcomes at any time point, except for more decreased pain at rest in the intervention group (n ¼ 28) compared with the control group (n ¼ 27) after 12 months. The per-protocol analyses did not change these results. Fifteen participants experienced 1 or more adverse events during the first 3 months, but the types and frequencies of adverse events were similar between the 2 groups.Conclusions A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis.

Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial

“…To avoid bias, we decided to immobilize patients in both groups for the same period of 4 weeks, which is commonly used after trapeziectomy. However, there is a wide variety in the duration of immobilization with a tendency towards shorter immobilization periods (Hermann-Eriksen et al., 2022; Howard et al., 2011; Tchurukdichian et al., 2020; Thien et al., 2007; Wouters et al., 2018). Long immobilization may have negatively influenced the various grip strengths, activities of daily living and return to work.…”

Wrist & Hand

“…Researchers from Oslo (Norway) performed a randomized controlled non-inferiority trial comparing two weeks of cast followed by gentle commencement of normal activities with a soft neoprene splint as the early mobilization group, and two weeks of cast immobilization followed by a rigid orthosis for four weeks as the control group. 3 The primary outcome measure was activity performance as measured by the Canadian Occupational Performance Measure, which is an interview-based outcome score where higher scores reflect better performance. Secondary outcome measures included grip and pinch strength, range of movement, and a subjective measure of pain.…”