Thumb Carpometacarpal Joint Denervation Has Lower Reoperation Rates Than Trapeziectomy for Thumb Base Arthritis: A Retrospective Database Study

Abstract

Purpose

Various surgical options exist to treat thumb carpometacarpal (CMC) osteoarthritis, including trapeziectomy-based procedures and CMC denervation. Presently, there is limited data on the relative longevity of these 2 procedures, with conflicting data on the rates of secondary conversion after CMC denervation. We sought to investigate the rates of secondary surgery in patients undergoing trapeziectomy or denervation for CMC osteoarthritis.

Methods

The PearlDiver Mariner Database was retrospectively queried for patients with CMC arthritis undergoing trapeziectomy-based procedures or CMC denervation. A propensity score-matched analysis was conducted. The primary end point was all-cause reoperation rates, including neuroma excision, secondary trapeziectomy, arthrodesis, and arthroplasty, however, excluding hardware removals, at 2 years after surgery. Univariate and multivariable analyses were performed to assess whether CMC denervation offered a protective effect on reoperation rates. P values of <.05 were considered statistically significant.

Results

Five hundred forty patients who underwent CMC denervation were matched to 540 patients who underwent trapeziectomy. Cohorts were well balanced (standardized mean difference [SMD], <0.1), including age (64.1 vs 63.8 years), comorbidity burden (Elixhauser Comorbidity Index, 4.8 vs 5.0), and sex (male, 32.6% vs 29.6%). The denervation cohort experienced lower rates and adjusted odds of all-cause reoperation than the trapeziectomy cohort at 2 years (3.3% vs 7.8%, P = .002; adjusted odd, 0.4 [0.2–0.7], P = .002).

Conclusions

Carpometacarpal denervation was associated with significantly lower reoperation than trapeziectomy at 2 years. Integrating denervation into treatment algorithms prior to proceeding with more invasive procedures has the potential to provide short- to mid-term longevity; however, more data are needed to validate these results.

Type of study/level of evidence

Therapeutic III.