Surgery for Trapeziometacarpal Joint Arthritis: A Network Meta-Analysis of Randomized Studies.

Purpose: Our aim was to compare the efficacy and safety of the available surgical interventions for trapeziometacarpal joint (TMCJ) arthritis. Methods: We conducted a systematic review and network meta-analysis of randomized studies comparing surgical interventions for TMCJ arthritis. Our primary outcome was patient-reported pain, and secondary outcomes were patient-reported functional disability, key pinch strength, and complications. Mean differences (MD) and standardized mean differences (SMD) were calculated for continuous outcomes and odds ratios (OR) for dichotomous outcomes, all with 95% confidence intervals. Results: Twenty-one randomized studies were included. In pairwise meta-analyses, when simple trapeziectomy was compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI), all pain, functional disability, and key pinch strength were similar (pain visual analogue scale, MD 0.22 points [-0.66 to 0.21]; functional disability, SMD 0.17 [-0.06 to 0.41]; key pinch strength, MD 0.07 kg [-0.22 to 036], Conclusions: Total joint arthroplasty appears to be at least as effective as trapeziectomy for pain relief and functional disability and may be superior for key pinch strength in the short-term. Until long-term efficacy, complication, and survivorship data arising from high-quality comparative studies become available, its widespread use cannot be recommended. Type of study/level of evidence: Therapeutic II.