Differences between simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis | Archives of Orthopaedic and Trauma Surgery Skip to main content

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Differences between simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis

  • Orthopaedic Surgery
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Abstract

Background

The optimal management of trapeziometacarpal osteoarthritis remains controversial. This systematic review and meta-analysis assessed the subjective and objective outcomes and complications of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI).

Methods

The PubMed, Embase, Web of science, and Cochrane electronic databases were searched from inception to Aug 31, 2020. Key words included “osteoarthrosis”, “carpometacarpal joint”, and “trapeziectomy”. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for trapeziometacarpal osteoarthritis were included. The subjective outcomes (visual analog scale [VAS] and disabilities of the arm, shoulder, and hand questionnaire scores), objective outcomes (grip strength, tip, and key pinch strength) and complications were extracted. The methodological quality of each was assessed independently. Meta-analysis was performed for comparative trials. The protocol for this meta-analysis is available in PROSPERO (CRD42020195752).

Results

From the 8 included studies (7 RCTs, 1 CCT), 656 cases were divided into T (n = 325) and T + LRTI (n = 331) groups. Compared with the T group, grip and tip pinch strength was better in the T + LRTI group (SMD = − 2.74, 95% confidence interval (CI) (− 3.46 to − 2.02), P < 0.00001) and (SMD = − 0.21, 95% CI (− 0.34 to − 0.08), P = 0.002), respectively, but there were significantly more complications 3 months after operation in the T + LRTI group (RR = 0.50, 95% CI (0.31 to 0.80), P = 0.004). The VAS score (SMD = 0.33, 95% CI (− 0.39 to 1.04), P = 0.37), DASH (SMD = − 1.86, 95% CI (− 7.59 to 3.87), P = 0.52), key pinch strength (SMD = − 0.13, 95% CI (− 0.28 to 0.01), P = 0.07), and incidence of complications 1 year after operation (RR = 0.83, 95% CI (0.53–1.29), P = 0.41) were not significantly different between the two groups.

Conclusion

While the T + LRTI group demonstrated a better effect in grip and tip pinch strength at the one-year follow-up, there was no statistical difference in key pinch strength, pain relief, and DASH. Furthermore, T + LRTI has more latrogenic injury, more short-term postoperative complications, and higher surgical costs. Considered comprehensively, if there is no special strength requirement, we recommend simple trapeziectomy.

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Abbreviations

T:

Trapeziectomy

T + LRTI:

Trapeziectomy with ligament reconstruction and tendon interposition

VAS:

Visual analog scale

DASH:

Disabilities of the Arm, Shoulder and Hand questionnaire scores

T + TI:

Trapeziectomy with tendon interposition

CI:

Confidence intervals

SD:

Standard deviation

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No external funding was received for the initiation or completion of this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Korea

    Quanzhe Liu, Bin Xu, Haozhen Lyu & Jae Hyup Lee

  2. Department of Orthopedic Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramaero 5-gil, Dongjak-gu, Seoul, 07061, Korea

    Jae Hyup Lee

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  1. Quanzhe Liu
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Correspondence to Jae Hyup Lee.

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Liu, Q., Xu, B., Lyu, H. et al. Differences between simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 142, 987–996 (2022). https://doi.org/10.1007/s00402-020-03707-w

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