A Prospective Comparison Study of Denervation Versus Suspension Arthroplasty for Carpometacarpal Arthritis of the Thumb
Sorka T Deeyor, BS1; Arjun Vohra, MD1; Haroon (Aaron) Kisana, MD, MS1; Aaron Llanes, MS1; Christina M Regan, BS1; Clayton Hui, BSE1; Joshua W. Hustedt, MD, MHS2; Briana Silvestri, PA-C1
1The University of Arizona College of Medicine – Phoenix, Phoenix, AZ; 2Orthopedics, University of Arizona-Phoenix College of Medicine, Phoenix, AZ
Introduction: Trapeziectomy with suspensionplasty has been considered the "gold standard" for treatment of thumb carpometacarpal arthritis in the United States. However, carpometacarpal denervation has recently shown promise as an alternative treatment option. This study was designed to compare functional outcomes, patient satisfaction, quality of life, and cost effectiveness between denervation and suspension arthroplasty in patients treated for thumb carpometacarpal osteoarthritis.
Methods: We conducted a prospective clinical trial between November 2019 and April 2021. Pre and postoperative evaluations of were conducted on patients including evaluation of pain with the visual analogue score, functional outcomes with the Michigan Hand Questionnaire and evaluation of time to return to work, quality of life with EQ-5D, and actual surgical reimbursements provided by our ambulatory surgery center. Outcomes and complications were compared between patients undergoing denervation versus arthroplasty.
Results: Fifty-seven patients were included in the study, of which 47 underwent denervation and 10 suspension arthroplasty. Patient characteristics were similar between the two groups, with an average age of 55 in the denervation and 56 in the arthroplasty groups. Pain reduction, functional outcomes, and quality of life scores showed equal improvement in both groups. Denervation patients had a significantly decreased time to return to function (3 weeks versus 9 months in the arthroplasty group). Denervation was also significantly less expensive than arthroplasty.
Conclusion: Carpometacarpal denervation appears to provide similar outcomes as suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. Treatment with denervation offers a quicker return to function at a cheaper cost.
Level of Evidence: II
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