Cochrane Summaries

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Surgery for osteoarthritis of the thumb

Wajon A, Carr E, Edmunds I, Ada L
Published Online: 
7 October 2009

This summary of a Cochrane review presents what we know from research about the effect of surgery on osteoarthritis of the thumb.

The review shows that in people with osteoarthritis, trapeziectomy with ligament reconstruction and tendon interposition:

- may not improve your pain compared with trapeziectomy;

- may improve your physical function compared with trapeziectomy;

- will probably lead to more side effects.

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects.

What is osteoarthritis of the thumb and why surgery?

Osteoarthritis is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. Osteoarthritis (OA) at the base of the thumb (or trapeziometacarpal joint) causes pain, stiffness and weakness in the thumb. This can affect how well the thumb moves, how strong a person's grip is, and how well a person can do routine things at home or at work. There are many types of surgery for the base of the thumb. The simplest surgery is 'trapeziectomy'. Other surgeries use this simple approach but will also work on ligaments and tendons at the thumb or replace the thumb joint.  For example, trapeziectomy with ligament reconstruction and tendon interposition takes this approach.

Best estimate of what happens to people with osteoarthritis who have surgery: 

Pain

- People who had trapeziectomy with ligament reconstruction and tendon interposition rated their pain to be 3 mm (millimetres) better after this surgery compared to trapeziectomy (3% absolute improvement), although this difference could have happened by chance.

- People who had trapeziectomy rated their pain to be between 16 and 37 mm on a scale of 0 to 100 mm after the surgery.

- People who had trapeziectomy with ligament reconstruction and tendon interposition rated their pain to be 3 mm better after this surgery compared to trapeziectomy, although this difference could have happened by chance.

Physical function

- People who had trapeziectomy rated their ability to move normally to be between 30 and 33 mm on a scale of 0 to 100 mm after the surgery.

- People who had trapeziectomy with ligament reconstruction and tendon interposition rated their ability to function normally to be 3 mm worse after this surgery compared to trapeziectomy, although this difference could have happened by chance.

Side effects

- 12 more people out of 100 had side effects like scar tenderness, or tendon damage (a tendon is tissue that connects the muscle to the bone) following trapeziectomy with ligament reconstruction and tendon interposition (12% absolute difference).

- 11 people out of 100 who had trapeziectomy had side effects.

- 23 people out of 100 who had trapeziectomy with ligament reconstruction and tendon interposition had side effects. 

This record should be cited as: 
Wajon A, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004631. DOI: 10.1002/14651858.CD004631.pub3
Assessed as up to date: 
30 March 2009
Arthritis topics: