Thumb Carpometacarpal Denervation Has Grown in Popularity Since 2019
Daniel A Portney, M.D.1, Cody Lee, M.D.1, Walaa Abdelfadeel, M.D.1, Jason Strelzow, MD2 and Jeffrey G Stepan, MD, MS2, (1)University of Chicago, Chicago, IL, (2)University of Chicago Medical Center, Chicago, IL
Thumb carpometacarpal arthritis (CMC OA) is a common diagnosis with growing incidence as the population ages. CMC denervation is growing in popularity as a less invasive surgical option, however no studies have quantified the recent trends in the incidence of CMC denervation in this population. We hypothesized that, on a population level, there will have been a significant increase in the incidence of CMC denervation in the past five years, and moreover, patients undergoing CMC denervation will be younger than those receiving other forms of surgical treatment.
We queried the PearlDiver database from 2010 to 2021 to identify patients treated surgically for CMC OA, 75,547 patients were identified. A total of 732 patients were identified with CMC denervation over this time period. The incidence of each surgery (per 100,000) was collected on an annual basis from 2010 to 2021 (Figure 1A) and normalized to the 2010 level (Figure 1B). Chi-square tests and odds ratios were used to compare proportions between groups. Multiple variable logistic regression was used to identify factors associated with higher rates of CMC denervation. A p-value of 0.005 was selected for significance accounting for the Bonferroni correction.
Overall, denervation comprised only 1.0% of surgeries for CMC OA, the most common surgery was trapeziectomy with suspension arthroplasty which comprised 89.8% of patients. There was 3.7-fold increase in the incidence of denervation since 2010 compared to a 2.2-fold increase in the incidence of non-denervation CMC OA surgery over that same time (Figure 1B). Patients who had denervation were 49% male compared to 24% male in the non-denervation group and were of similar ages 63±8 vs 62±8 years in the denervation and non-denervation cohorts respectively. On logistic regression analysis, male gender (OR 3.0, 95% CI 2.6-3.5), surgery in the western United States (OR 1.4, 95% CI 1.2-1.8), and those with concomitant wrist arthritis (OR 4.9, 95% CI 4.2-5.6) were all associated with higher likelihood of denervation (p<0.0001 for all three) (Table 1).
In this large database, only 1% of CMC OA surgery was denervation from 2010-2021, but there was a 3.7-fold increase over that time period, compared to only a 2.2-fold increase in non-denervation surgery. Additionally, denervation was more often seen in male patients, those in the Western United States, and those with concomitant wrist arthritis. As denervation for CMC OA becomes more prevalent, more data is needed on both short and long-term outcomes.
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