PDF(Pubmed)
Abstract：
Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies.
We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis.
We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA\'s benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4).
Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis.
We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA\'s benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4).
Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
摘要：
目的：全关节置换术(TJA)治疗足掌(CMC)关节骨关节炎(OA)越来越多。我们旨在对TJA治疗拇指CMCOA与其他治疗策略相比的益处和危害进行系统评价和荟萃分析。
方法：我们于2023年8月2日对MEDLINE和CENTRAL数据库进行了系统搜索。我们纳入了随机对照试验，研究了TJA在拇指CMC关节OA患者中的作用，无论疾病的阶段或病因或比较物如何。结果与随机效应荟萃分析进行汇总。
结果：我们确定了4项研究，将420名参与者随机分为TJA或梯形切除术。3个月时,TJA对疼痛的益处可能超过临床上重要的差异。然而,1年随访后,与梯形切除术相比,TJA不能改善疼痛(0~10量表平均差0.53分;95%可信区间[CI]0.26~0.81).此外，它在3个月时在手功能上提供了短暂的益处(用手臂残疾来衡量，肩膀,和手问卷，0-100，越低越好）与有或没有韧带重建肌腱插入的梯形切除术相比。在1年的随访中，功能上的益处下降到临床上不重要的水平（高4.4分；CI0.42-8.4）。
结论：TJA在手功能方面的短暂获益意味着对于那些认为术后快速恢复很重要的人来说，TJA在手功能方面可能是一个优于梯形切除术的选择。然而,目前的证据未能告知我们TJA是否比梯形切除术具有长期更高的修正风险.
方法：我们于2023年8月2日对MEDLINE和CENTRAL数据库进行了系统搜索。我们纳入了随机对照试验，研究了TJA在拇指CMC关节OA患者中的作用，无论疾病的阶段或病因或比较物如何。结果与随机效应荟萃分析进行汇总。
结果：我们确定了4项研究，将420名参与者随机分为TJA或梯形切除术。3个月时,TJA对疼痛的益处可能超过临床上重要的差异。然而,1年随访后,与梯形切除术相比,TJA不能改善疼痛(0~10量表平均差0.53分;95%可信区间[CI]0.26~0.81).此外，它在3个月时在手功能上提供了短暂的益处(用手臂残疾来衡量，肩膀,和手问卷，0-100，越低越好）与有或没有韧带重建肌腱插入的梯形切除术相比。在1年的随访中，功能上的益处下降到临床上不重要的水平（高4.4分；CI0.42-8.4）。
结论：TJA在手功能方面的短暂获益意味着对于那些认为术后快速恢复很重要的人来说，TJA在手功能方面可能是一个优于梯形切除术的选择。然而,目前的证据未能告知我们TJA是否比梯形切除术具有长期更高的修正风险.
