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Surgical Denervation of the First Carpometacarpal Joint for Osteoarthritis: A Systematic Review
Arthur S Lanoux-Nguyen, MD; Jordan M Rasmussen, BS; Kai Yang, MD
University of Nebraska Medical Center, Omaha, NE
Introduction Osteoarthritis of the first carpometacarpal joint (CMCJ) is a common, progressive, and debilitating condition that impacts quality of life. Treatment focuses on relieving pain, improving hand function and joint mobility, and restoring anatomy. When conservative, non-operative measures fail, surgical approaches including arthroplasty, arthrodesis, and trapeziectomy with or without ligament reconstruction aim to provide more durable and definitive results. However, these more invasive interventions are not without complications. Recent literature describes joint denervation surgery as an alternative and minimally-invasive solution that yields decreased pain and expedited recovery times for patients suffering from first CMCJ osteoarthritis. In this study, we provide an updated and comprehensive review of the current literature to assess the long-term efficacy and role of denervation in first CMCJ osteoarthritis treatment.
Methods A literature review was conducted using EMBASE, MEDLINE, Cochrane Library, and Scopus databases to identify studies of adult patients undergoing denervation of the first CMCJ for osteoarthritis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Two reviewers performed the screening process, data collection and analysis, and study quality assessment using the Newcastle-Ottawa Scale (NOS) for non-randomized studies and the National Institutes of Health (NIH) Quality Assessment Tool for case series. Data were collected on patient demographics, pre-operative characteristics, surgical technique, post-operative outcomes, and complications.
Results Fifteen studies met inclusion criteria for analysis (12 case series, 3 cohort studies) for a total of 360 patients and 372 hands. Mean follow-up time was 35.5 months (range 6-125.6 months). First CMCJ denervation consistently demonstrated reduced pain and improved hand function. Overall pain score reduction was 75.3% with pooled analysis of 9 studies showing a significant reduction in pre- and post-operative pain scores (PRE: 7.13, SD 1.15; POST: 1.77, SD 0.64,
p < 0.001). The complication rate across studies was 18.5% with post-operative paresthesias as the most often reported complaint (12.8%). Wound-related complications and infections were 3%. Conversion rate of 16.3% to trapeziectomy with ligament reconstruction was reported in seven studies with mean follow-up time of 36.9 months (range 12-63.5 months).
Conclusion Surgical denervation is a promising, alternative treatment for patients with osteoarthritis of the first CMCJ. Long-term studies demonstrate success in diminishing overall pain, while minimizing post-operative complications and the need for conversion arthroplasty. In the present large-scale study, denervation proves to be an effective and lasting treatment for first CMCJ osteoarthritis.
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