Surgical Treatment for Trapeziometacarpal Osteoarthritis:A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 YIN Zhonggang , WANG Xiaogang , KAN Shilian

Department of hand and microsurgery, Tianjin Hospital, Tianjin 300211, China;

Corresponding author：

YIN Zhonggang, Email: zgyin@hotmail.com

Keywords：

Carpometacarpal joint; Osteoarthritis; Surgical treatment; Systematic review

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Objective　 To compare the effectiveness and complications of various surgical techniques in the treatment of the osteoarthritis of the trapeziometacarpal joint.
Methods 　We searched MEDLINE (1966 to 2005), Cochrane Controlled Trials Register (Issue 3, 2005) and CBM (1978 to 2005), and handsearched the references of relevant studies. Only randomized controlled trials were included. We assessed the methodological quality of the included studies, extracted data, and performed quantitative and qualitative analyses.
Results 　Seven studies were included, and all had some methodological shortcomings. There was b evidence that in the short term, ligamentous reconstruction, tendon interposition (LRTI) and trapeziectomy alone provide similar results with regard to pain relief, grip and pinch strength, range of thumb motion, hand function and overall satisfaction of patients, but more complications occur with LRTI than with trapeziectomy alone. Conflicting evidence was found about whether LRTI resulted in less subsidence of the first metacarpal bone than trapeziectomy alone. There was moderate evidence that LRTI and ligament reconstruction without tendon interposition (LR) did not have significant differences in thumb strength, patient satisfaction and subsidence of the first metacarpal bone. Limited evidence showed that LR produced better functional scores than LRTI and similar results in pain relief to LRTI. Conflicting evidence supported that LR resulted in greater motion range of thumb than LRTI. Only limited evidence showed that effectiveness was similar between LRTI and Swanson implant. We did not find randomized controlled trials about other surgical techniques.
Conclusion　 Not enough evidence supports superiority of one technique over another. More high quality randomized controlled trials and long term follow-up are necessary.

Citation： YIN Zhonggang,WANG Xiaogang,KAN Shilian. Surgical Treatment for Trapeziometacarpal Osteoarthritis:A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(3): 179-188. doi: Copy

1.	Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteotomy for trapeziometacarpal osteoarthritis. J Bone Joint Surg Br, 1998; 80(3): 508-512.
2.	Bamberger HB, Stern PJ, Kiefhaber TR, et al. Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg [Am], 1992; 17(4): 605-611.
3.	Dhar S, Gray IC, Jones WA, et al. Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg [Br], 1994; 19(4): 485-488.
4.	Lins RE, Gelberman RH, McKeown L, et al. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg [Am], 1996; 21(2): 202-209.
5.	Varley GW, Calvey J, Hunter JB, et al. Excision of the trapezium for osteoarthritis at the base of the thumb. J Bone Joint Surg Br, 1994; 76(6): 964-968.
6.	Van Cappelle HG, Deutman R, van Horn JR. Use of the Swanson silicone trapezium implant for treatment of primary osteoarthritis: long-term results. J Bone Joint Surg Am, 2001; 83-A(7): 999-1004.
7.	Swanson AB, de Groot Swanson G, DeHeer DH, et al. Carpal bone titanium implant arthroplasty. 10 years’ experience. Clin Orthop Relat Res, 1997; (342): 46-58.
8.	Chakrabarti AJ, Robinson AH, Gallagher P. De la Caffiniere thumb carpometacarpal replacements. 93 cases at 6 to 16 years follow-up. J Hand Surg [Br], 1997; 22(6): 695-698.
9.	Van Cappelle HG, Elzenga P, van Horn JR. Long-term results and loosening analysis of de la Caffiniere replacements of the trapeziometacarpal joint. J Hand Surg [Am], 1999; 24(3): 476-482.
10.	Wachtl SW, Guggenheim PR, Sennwald GR. Cemented and non-cemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br, 1998; 80(1):121-125.
11.	Gerritsen AAM, Uitdehaag BMJ, van Geldere D, et al. Systematic review of randomized clinical trials of surgical treatment for carpal yunnel syndrom. Br J Surg, 2001; 88(10): 1285-1295.
12.	Gerwin M, Griffith A, Weiland AJ, et al. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res, 1997; (342): 42-45.
13.	Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg [Br], 2000; 25(4): 350-356.
14.	Tagil M, Kopylov P. Swanson versus APL arthroplasty in the treatment of osteoarthritis of the trapeziometacarpal joint: a prospective and randomized study in 26 patients, J Hand Surg [Br], 2002; 27(5): 452-456.
15.	Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg [Am], 2001; 26(5): 862-868.
16.	Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg [Am], 2004; 29(6): 1069-1077.
17.	De Smet L, Sioen W, Spaepen D, et al. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg, 2004; 9(1): 5-9.
18.	Kriegs-Au G, Petje G, Fojtl E, et al. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am, 2004; 86-A(2): 209-218.
19.	Davis TR, Brady O, Barton NJ, et al. Trapeziectomy alone, with tendon interposition or with ligament reconstruction? J Hand Surg [Br], 1997; 22(6): 689-694.
20.	Egger M, Zellweger-Zahner T, Schneider M, et al. Language bias in randomised controlled trials published in English and German. Lancet, 1997; 350(9074): 326-329.
21.	Scherer RW, Dickersin K, Langenberg P. Full publication of results initially presented in abstracts. A meta-analysis. JAMA, 1994; 272(2): 158-162.
22.	Egger M, Davey Smith G. Bias in location and selection of studies. BMJ, 1998; 316: 61-66.
23.	Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA, 1999; 282(11): 1054-1060.
24.	van Tulder MW, Esmail R, Bombardier C, et al. Back schools for non-specific low back pain (Cochrane Review). In: The Cochrane Library, 2005, Issue 3.
25.	van Tulder MW, Scholten RJ, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain (Cochrane Review). In: The Cochrane Library, 2005, Issue 3.
26.	Bellamy N, Kirwan J, Boers M, et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol, 1997; 24(4): 799-802.
27.	Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am, 1995; 77(3): 346-355.
28.	Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ, 1998; 316(7125): 140-144.
29.	Audige L, Bhandari M, Griffin D, et al. Systematic reviews of nonrandomized clinical studies in the orthopaedic literature. Clin Orthop Relat Res, 2004; (427): 249-257.

1. Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteotomy for trapeziometacarpal osteoarthritis. J Bone Joint Surg Br, 1998; 80(3): 508-512.
2. Bamberger HB, Stern PJ, Kiefhaber TR, et al. Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg [Am], 1992; 17(4): 605-611.
3. Dhar S, Gray IC, Jones WA, et al. Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg [Br], 1994; 19(4): 485-488.
4. Lins RE, Gelberman RH, McKeown L, et al. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg [Am], 1996; 21(2): 202-209.
5. Varley GW, Calvey J, Hunter JB, et al. Excision of the trapezium for osteoarthritis at the base of the thumb. J Bone Joint Surg Br, 1994; 76(6): 964-968.
6. Van Cappelle HG, Deutman R, van Horn JR. Use of the Swanson silicone trapezium implant for treatment of primary osteoarthritis: long-term results. J Bone Joint Surg Am, 2001; 83-A(7): 999-1004.
7. Swanson AB, de Groot Swanson G, DeHeer DH, et al. Carpal bone titanium implant arthroplasty. 10 years’ experience. Clin Orthop Relat Res, 1997; (342): 46-58.
8. Chakrabarti AJ, Robinson AH, Gallagher P. De la Caffiniere thumb carpometacarpal replacements. 93 cases at 6 to 16 years follow-up. J Hand Surg [Br], 1997; 22(6): 695-698.
9. Van Cappelle HG, Elzenga P, van Horn JR. Long-term results and loosening analysis of de la Caffiniere replacements of the trapeziometacarpal joint. J Hand Surg [Am], 1999; 24(3): 476-482.
10. Wachtl SW, Guggenheim PR, Sennwald GR. Cemented and non-cemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br, 1998; 80(1):121-125.
11. Gerritsen AAM, Uitdehaag BMJ, van Geldere D, et al. Systematic review of randomized clinical trials of surgical treatment for carpal yunnel syndrom. Br J Surg, 2001; 88(10): 1285-1295.
12. Gerwin M, Griffith A, Weiland AJ, et al. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res, 1997; (342): 42-45.
13. Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg [Br], 2000; 25(4): 350-356.
14. Tagil M, Kopylov P. Swanson versus APL arthroplasty in the treatment of osteoarthritis of the trapeziometacarpal joint: a prospective and randomized study in 26 patients, J Hand Surg [Br], 2002; 27(5): 452-456.
15. Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg [Am], 2001; 26(5): 862-868.
16. Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg [Am], 2004; 29(6): 1069-1077.
17. De Smet L, Sioen W, Spaepen D, et al. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg, 2004; 9(1): 5-9.
18. Kriegs-Au G, Petje G, Fojtl E, et al. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am, 2004; 86-A(2): 209-218.
19. Davis TR, Brady O, Barton NJ, et al. Trapeziectomy alone, with tendon interposition or with ligament reconstruction? J Hand Surg [Br], 1997; 22(6): 689-694.
20. Egger M, Zellweger-Zahner T, Schneider M, et al. Language bias in randomised controlled trials published in English and German. Lancet, 1997; 350(9074): 326-329.
21. Scherer RW, Dickersin K, Langenberg P. Full publication of results initially presented in abstracts. A meta-analysis. JAMA, 1994; 272(2): 158-162.
22. Egger M, Davey Smith G. Bias in location and selection of studies. BMJ, 1998; 316: 61-66.
23. Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA, 1999; 282(11): 1054-1060.
24. van Tulder MW, Esmail R, Bombardier C, et al. Back schools for non-specific low back pain (Cochrane Review). In: The Cochrane Library, 2005, Issue 3.
25. van Tulder MW, Scholten RJ, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain (Cochrane Review). In: The Cochrane Library, 2005, Issue 3.
26. Bellamy N, Kirwan J, Boers M, et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol, 1997; 24(4): 799-802.
27. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am, 1995; 77(3): 346-355.
28. Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ, 1998; 316(7125): 140-144.
29. Audige L, Bhandari M, Griffin D, et al. Systematic reviews of nonrandomized clinical studies in the orthopaedic literature. Clin Orthop Relat Res, 2004; (427): 249-257.

Chinese Journal of Evidence-Based Medicine

Surgical Treatment for Trapeziometacarpal Osteoarthritis:A Systematic Review

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