Comparison of Surgical Techniques and Joint Injections for Base of Thumb Osteoarthritis: A Systematic Review

Purpose: To perform an updated systematic review investigating the various surgical and injection interventions for thumb carpometacarpal (CMC) joint arthritis. Methods: A systematic literature search was conducted in MEDLINE, Embase, Web of Science, and Cochrane databases from inception to April 2024 to identify prospective, randomized studies comparing surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months. Reference lists of previous reviews were screened to identify additional publications. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference) because of marked heterogeneity of data and inadequate statistical power. Cochrane's risk of bias 2 tool assessed the quality of included studies. Results: Seventeen studies encompassing 1,166 thumbs were included in this review. Fourteen studies compared surgical interventions, whereas three studies compared various intra-articular injections. Five studies had a low risk of bias, eight had a moderate risk of bias, and four had a high risk of bias. Regarding primary outcomes, there was no difference in function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis. Arthrodesis was associated with a higher complication rate compared with trapeziectomy. Platelet-rich plasma injections had improved pain, function, and patient satisfaction outcomes compared with corticosteroid injections. Conclusions: No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Platelet-rich plasma injections may be a useful alternative to corticosteroids in first CMC osteoarthritis. Type of study/level of evidence: Therapeutic IB.