THU0746-HPR Efficacy of surgical treatments for pain associated with trapeziometacarpal (THUMB BASE) osteoarthritis: a systematic review
Authors: T. Hamasaki, S. Laprise, P.G. Harris, D. Ziegler, H.T.V. Zomahoun, N.J. Bureau, N. Gaudreault, M. Choinière
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Trapeziometacarpal osteoarthritis (TMO) is a highly prevalent, painful, and debilitating disorder. Unfortunately, TMO management remains suboptimal and this is in part due to the lack of knowledge on evidence-based care management. The aim of this systematic review (SR) is to document the efficacy of existing surgical interventions for reducing TMO pain. <h3>Methods</h3> We performed this SR according to the Cochrane intervention review methodology. Trials and SRs assessing surgical intervention efficacy on TMO were identified via 16 databases and hand search via the included references. Studies selection, data extraction and methodological quality assessment were conducted by two independent reviewers. Effect estimates of interventions were extracted from SRs when available, otherwise estimated from randomised controlled trials (RCTs). If RCTs were not available, non-RCTs (NRCTs) were referred to. Characteristics and efficacy of interventions were quantitatively analysed. In addition, we rated the level of evidence quality by using the GRADE tool. <h3>Results</h3> A total of 8 SRs, 16 RCTs and 41 NRCTs were identified. Most of these studies had unclear to high risk of biases which may have compromised their results. More than 40 comparisons of different surgical interventions were identified, including arthroscopic debridement (AD) (n=2 studies); 1 st metacarpal osteotomy (n=3); resection of 1 st metacarpal/trapezium (R) (n=3); arthrodesis (A) (n=14); trapeziectomy (T) (n=16); hematoma distraction arthroplasty (n=5); ligament reconstruction (LR) (n=5); tendon interposition (TI) (n=13); LRTI (n=17); and manufactured implants - Arex (n=1), Artelon (n=7), chondrocostal autograft (n=4), De la Caffinière (n=5), Elektra (n=5), Graftjacket (n=1), Gore-Tex (n=6), Guepar (n=3), Ledoux (n=2), Maia (n=1), Marlex (n=5), porcine dermal collagen xenograft (n=2), pyrocarbon Pi<sub>2</sub> (n=5), PyroDisk (n=1), Pyrocardan (n=1), and Swanson (n=11). The effect sizes of most of the interventions were small (standardised mean differences 0.04–4.81, risk ratios 1.05–11.1) and/or their 95% confidence intervals included null value. Nonetheless, the superiority of the following interventions was supported by the evidence of very low to moderate quality: AD over conservative interventions; R+GraftJacket over R; A over R, T+TI and T+LRTI; partial T+chondrocostal autograft over T; T over T+porcine xenograft; T+TI over Artelon; T+LRTI+ bone tunnel over T+LRTI without tunnel for a short-term period; T+LRTI over T+LRTI+ Mitek anchor suture; T+Elektra over T+TI; PyroDisk over Pyrocardan. <h3>Conclusions</h3> This SR allowed collating comprehensive evidence on the efficacy of surgical interventions for TMO pain. Based on the available scientific evidence, arthrodesis appears superior to other interventions (R, T+TI and T+LRTI) to alleviate pain, however, adverse effects (e.g., nonunion) have been reported. Thus, it goes without saying that when choosing a proper surgical intervention for TMO, not only its analgesic effects but also the risk and gravity of adverse effects must be taken into consideration. <h3>Disclosure of Interest</h3> None declared