Clinical Significance of Arthroscopic Debridement, Trapeziectomy, and Joint Replacement for Basilar Thumb Joint Arthritis: A Meta-analysis of Pain Score Improvements.

Abstract

Introduction: A meta-analysis was conducted comparing the impact of Arthroscopic debridement (AD), trapeziectomy (TRAP), and joint replacement (JR) on the change in pain scores on patients with Basilar thumb joint arthritis (BTJA).

Methods: Four databases were searched for studies presenting pain outcomes following surgical intervention for BTJA. Pain scores were reported using the Visual Analog Scale (VAS) and compared against the pre-established threshold for Minimal Clinically Important Difference (MCID) of 1.65.

Results: Eighteen studies with 763 patients treated with AD(n=102, 13%), TRAP(n=428, 56%), and JR(n=233, 31%) between 2010 and 2023 with a mean follow-up period of 38 ± 28 months were included. There were 25 groups including 4 AD, 14 TRAP, and 7 JR. The mean difference between pre- and post-operative VAS pain was 4.9 ± 2 for all groups. Meta-analysis demonstrated a mean delta VAS of 3.6 (95%CI 1.79-5.38, for AD, 5.1(95%CI, 4.20-6.02) for TRAP and 6.8(95%CI, 5.93-7.97) for JR. ANOVA showed a significant difference between groups (P=0.016). Post-Hoc testing showed a significant difference between AD and JR (P=0.014). A significant improvement in pain scores, surpassing the MCID threshold, was obtained in all surgical interventions. Change in pain score was 2.6 times MCID for AD, 2.9 times for TRAP, and 3.6 times for JR.

Conclusions: All interventions showed significant improvement in pain. Variability in treatment options and improvement depends on patient selection and surgeon's preference. This data can be used to counsel patients regarding the expected pain relief. However, longevity, and long-term outcomes warrant further study.