National Trends of Surgical Interventions for Thumb Carpometacarpal Arthritis From 2010 to 2022.

Abstract

Purpose: Thumb carpometacarpal arthritis is a common condition for which several surgical options are used: trapeziectomy with ligament reconstruction and tendon interposition (LRTI), other nonprosthetic arthroplasties without tendon transfer (eg, suture button suspensionplasty), trapeziectomy alone, arthrodesis, and prosthetic arthroplasty. The current study used a large, national, multi-insurance database to characterize utilization and factors associated with these surgical options over the years.

Methods: All adult patients who underwent one of the above-noted procedures were identified from 2010 to October 2022 using PearlDiver database. Patient characteristics were abstracted including clinical (age, sex, Elixhauser Comorbidity Index) and nonclinical (insurance plan, and geographic region) variables. Characteristics were compared with multivariable logistic regression to assess whether each influenced the odds of undergoing one procedure versus the others. Relative utilization of the different surgeries was assessed over the years of the study and changes in patient characteristics over time were compared with univariate linear regression.

Results: Of 160,387 patients identified, LRTI was performed for 97,595 (60.8%), other nonprosthetic arthroplasty for 46,371 (28.9%), trapeziectomy alone for 11,353 (7.1%), arthrodesis for 3,245 (2.0%), and prosthetic arthroplasty for 1,823 (1.1%). Various clinical and nonclinical variables were independently predictive of the surgery performed, the strongest being geographic region in which the surgery was performed. From 2010 to 2022, relative utilization, when compared with all other cohorts, only increased for nonprosthetic non-LRTI arthroplasty (from 27.1% to 35.7%, an absolute increase of 31.5%). Fewer cases of LRTI, trapeziectomy, arthrodesis, and prosthetic arthroplasty were performed (absolute decreases of 8.2%, 16.8%, 52.0%, and 44.9%, respectively).

Conclusions: Of surgical options to address thumb carpometacarpal arthritis, LRTI still predominates, but nonprosthetic arthroplasty was the only cohort increasing in utilization over the years. Both patient clinical and nonclinical factors were associated with receiving one surgical modality over the others.

Type of study/level of evidence: Therapeutic II.