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Joint Denervation for Thumb Carpometacarpal Osteoarthritis: A Multicenter Study on Reoperations and Long-Term Outcomes
Niek J. Nieuwdorp, MSc
1, Camille Blaaker, MSc
1, Esmee Kwee, MD
1, Erik T. Walbeehm, MD, PhD
2, Ruud W. Selles, PhD
1, J. Michiel Zuidam, MD, PhD
1, The Hand Wrist Study Group, .
1,2; Caroline A. Hundepool, MD, PhD
1,2(1)Erasmus MC, Rotterdam, Netherlands, (2)Xpert Clinics, Amsterdam, Netherlands
Introduction: Joint denervation has emerged as a promising treatment for thumb carpometacarpal (CMC) osteoarthritis (OA), offering benefits such as minimal invasiveness and preservation of joint mobility. However, adoption of this technique has been limited due to the lack of large-scale studies and insufficient data on its long-term effectiveness. This study aims to evaluate the long-term outcomes of joint denervation for thumb CMC OA and to identify prognostic factors of postoperative pain.
Material & Methods: This multicenter prospective study included patients with CMC OA who underwent joint denervation between March 2016 and November 2024. The primary outcome was the rate of reoperation for recurrent CMC joint complaints. Secondary outcomes included long-term pain, hand function, patient satisfaction, complication rates, and time to return to work. The Visual Analogue Scale (VAS, 0-100) for pain and function was recorded at baseline, 3 months, 12 months, and during long-term follow-up. A linear mixed model assessed VAS changes over time, while a joint model identified predictors of postoperative pain outcomes.
Results: A total of 69 patients (76 thumbs) were included. Extended denervation (including PIN/AIN) for CMC OA was performed in 30% of cases. After a median follow-up of 30 months (range: 6-110 months), 28% required a reoperation, with a median time to reoperation of 9 months. VAS pain during exertion improved significantly from 70 (95% CI: 64-75) at baseline to 50 (95% CI: 42-59) at 3 months (p = 0.001) and remained stable long-term among those not requiring reoperation. VAS function scores improved from 46 (95% CI: 39-53) to 60 (95% CI: 51-69) at 3 months (p = 0.030) and were sustained thereafter. Complications occurred in 8% of cases, and the median return to work was 3 weeks. At long-term follow-up, 66% of patients without reoperation said they would opt for the denervation again. Extended denervation resulted in 0.56 points less monthly improvement in pain scores compared to standard denervation (p < 0.001). Male patients experienced greater monthly pain reduction, improving 0.85 points more per month (p = 0.023).
Conclusions: Joint denervation is an effective treatment for CMC OA, offering rapid recovery and a low complication rate. Although 28% of thumbs required reoperation, most patients experienced sustained improvements in pain and hand function during long-term follow-up. Because extended denervation requires an additional incision and does not lead to improved pain outcomes, we advise against its use in the treatment of CMC OA.
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