Wu EJ, Fossum BW, Voort WV, Bayne CO, Szabo RM. Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis. World J Orthop 2024; 15(5): 435-443 [PMID: 38835687 DOI: 10.5312/wjo.v15.i5.435]
Corresponding Author of This Article
Robert M Szabo, MD, Professor, Department of Orthopaedic Surgery, UC Davis School of Medicine, Davis, Sacramento, CA 95817, United States. rmszabo@ucdavis.edu
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2024; 15(5): 435-443 Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.435
Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis
Edward J Wu, Bradley W Fossum, Wyatt Vander Voort, Christopher O Bayne, Robert M Szabo
Edward J Wu, Bradley W Fossum, Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN 55455, United States
Edward J Wu, Wyatt Vander Voort, Christopher O Bayne, Robert M Szabo, Department of Orthopaedic Surgery, UC Davis School of Medicine, Sacramento, CA 95817, United States
Author contributions: Wu EJ and Szabo RM conceptualized the study, performed the survey, and collected and reviewed the data; Wu EJ, Fossum BW, and Vander Voort WD performed the literature review and drafted the manuscript; Bayne CO participated in data acquisition and reviewed and revised the manuscript; Szabo RM reviewed and revised the manuscript and supervised all aspects of the project; All authors have read and approved the final manuscript.
Institutional review board statement: IRB approval for this study was not required as it did not involve human or animal subjects but was an email survey of surgeons.
Informed consent statement: Informed consent was not required as this was a survey study administered by email correspondence. Implied consent was provided by each respondent by their completion of the de-identified survey.
Conflict-of-interest statement: All authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: No additional data are available. IRB approval for this study was not required as it did not involve human or animal subjects.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert M Szabo, MD, Professor, Department of Orthopaedic Surgery, UC Davis School of Medicine, Davis, Sacramento, CA 95817, United States. rmszabo@ucdavis.edu
Received: December 6, 2023 Revised: April 6, 2024 Accepted: April 16, 2024 Published online: May 18, 2024 Processing time: 160 Days and 14.2 Hours
Abstract
BACKGROUND
Primary thumb carpometacarpal (CMC) osteoarthritis is one of the most common conditions encountered by hand surgeons. Of the vast number of operations that have been proposed, none have demonstrated results significantly superior to trapeziectomy alone.
AIM
The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.
METHODS
A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis. Surgeons were contacted by e-mail once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.
RESULTS
Of 950 responses were received. 40.5% of surgeons preferred trapeziectomy + ligament reconstruction tendon interposition (LRTI), followed by trapeziectomy + suspensionplasty (28.2%), suture button suspension (5.9 %), trapeziectomy alone (4.6%), prosthetic arthroplasty (3.2%), arthrodesis (1.1%), and other (6.6%). Proponents of trapeziectomy + LRTI cited familiarity (73.2%), exposure during fellowship (48.8%) and less proximal migration (60%) to be the main reasons affecting their decision. Surgeons who preferred trapeziectomy + suspensionplasty most reported simplicity (74.9%), fewer complications (45.3%), less proximal migration (43.8%), and avoidance of autogenous tissue harvest (42.7%). Advocates of suture button suspension cited avoidance of autogenous tissue harvest (80.4%), shorter immobilization (76.8%), and quicker recovery (73.2%) with their technique. Advocates of trapeziectomy alone cited simplicity (97.7%), fewer complications (86.4%), and avoidance of autogenous tissue harvest (59.1%). In their comments, 45% of surgeons choosing trapeziectomy alone cited evidence as an additional rationale. Advocates of prosthetic arthroplasty cited improved pinch strength (83.3%) and improved range of motion (63.3%), while those preferring arthrodesis cited better pinch strength (90%) and frequently in their comments, durability. Of the surgeons who preferred a technique other than LRTI, 41.8% reported they had tried LRTI in the past, citing complexity of the procedure, flexor carpi radialis harvest, and longer operative time as reasons for moving on.
CONCLUSION
Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons' decision making in the management of thumb carpometacarpal osteoarthritis. Despite strong Level 1 evidence supporting the use of trapeziectomy alone, our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty. Several factors including familiarity, personal experience (Level 4 evidence), and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium. Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’ choice.
Core Tip: Despite strong evidence from level 1 prospective randomized studies that trapeziectomy alone is sufficient for the treatment of basilar thumb osteoarthritis, surgeons continue to perform more complicated operations with more complications. After surveying 950 fellowship trained hand surgeons, it seems that the majority are still performing trapeziectomy with ligament tendon interposition arthroplasty or suspensionplasty relying more on their level 4 clinical expertise and personal observations.
