Selective Thumb CMC Joint Denervation vs T+LRTI for Painful Arthritis: A Prospective Study with 2 years Follow Up
Visakha Suresh, MD1; Chris Frost, MD1; Pathik Aravind, MBBS1; John D Luck, MD2; William Padovano, MD3; Amy Quan, MD, MPH1; John V Ingari, MD4; Dawn M Laporte, MD4; Jaimie T Shores, MD5; Scott Lifchez, MD1
1Johns Hopkins University School of Medicine, Baltimore, MD; 2John Hopkins University School of Medicine, Baltimore, MD; 3Johns Hopkins University of School of Medicine, Baltimore, MD; 4Johns Hopkins Medicine, Baltimore, MD; 5Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Thumb carpometacarpal (CMC) joint osteoarthritis is common, affecting up to 85% of patients over the age of 70. CMC joint denervation is a relatively novel method for managing the pain associated with CMC arthritis by selectively transecting articular nerve branches to the CMC joint. This study compares functional outcomes and pain after denervation or trapeziectomy and ligament reconstruction with tendon interposition (T+LRTI) over a 2-year period. We hypothesized that denervation and T+LRTI outcomes would be similar over the study course.
This study was prospective and non-randomized, with surgery performed by 4 senior surgeons. Patients enrolled by JS and SL underwent denervation; those enrolled by DL and JI underwent T+LRTI. Inclusion criteria included Eaton-Littler stage 2-4 disease without CMC subluxation and no prior traumatic thumb injury or surgery. Patients undergoing other concurrent procedures on the same hand were excluded. Outcome measures included Kapandji score, pain scale, Brief Michigan Hand Questionnaire (bMHQ), 2-point discrimination, grip, key and 3-point pinch strength. Patients underwent follow up at 3, 6, 12, and 24 months. Post-operative routines varied by surgeon. T+LRTI patients were splinted for an average of 7 weeks with return to full activities at an average of 3 months; denervation patients were splinted for an average of 2 weeks with release to full activity as tolerated at 3 weeks.
57 patients were enrolled; 29 denervation and 21 T+LRTI patients were included in the final analysis. 2 patients in each study arm were lost to follow-up. 3/32 denervation patients underwent secondary T+LRTI during the study period; data prior to secondary surgery were included in analysis. Pre-operative characteristics were similar between both groups. Mean age was 61±8 and 65±7; Eaton-Littler scores were 2.94±0.7 and 2.65±0.48 between denervation and T+LRTI respectively (mean±SD). Average tourniquet time (minutes) for denervation and T+LRTI were 43.5±11.8 and 82.7±14.2, respectively (p<0.05). bMHQ scores were significantly higher in denervation and T+LRTI at all timepoints than preoperative baseline (p<0.05). Pain score was significantly lower in both groups at 6-, 12-, and 24-month time points (p<0.05) than preoperative baseline. No significant differences were found between denervation and T+LRTI at any timepoint for bMHQ, pain, Kapandji score, sensation, grip, key or 3-point pinch strength (Table 1).
CMC denervation is safe and well-tolerated with shorter tourniquet times and faster return to full activity than T+LRTI. Both procedures demonstrated durable improvement in pain and function compared to preoperative state with similar long-term outcomes over 2 years of follow-up.
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