Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review

Abstract

Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.

Trapezial Resection Arthroplasty: More Is Not Necessarily Better

“…The thumb carpometacarpal (CMC) joint (i.e. between the base of the thumb metacarpal and trapezium) is a common site for primary degenerative osteoarthritis in the hand [1]. Patients who have symptomatic osteoarthritis of the thumb carpometacarpal joint present with pain, typically worsened with the use of the hand and the thumb.…”

“…Initial treatment can include oral non-steroidal anti-inflammatory medication, splinting, and cortisone injection. When non-operative treatment fails to provide adequate relief of pain, surgery is an option [1]. The goal of surgery is pain relief and preservation/restoration of function.…”