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TYPE
Original Research
PAGE NO.
157-164
DOI
10.37547/tajmspr/Volume07Issue03-16A
OPEN ACCESS
SUBMITED
22 January 2025
ACCEPTED
29 February 2025
PUBLISHED
25 March 2025
VOLUME
Vol.07 Issue03 2025
CITATION
Bianca Gabriella de Oliveira, Andrey Santana Silva, Marina Lopes Cançado
Campos, Flávio Henrique Loyola Santos, & Arthur Vieira de Moraes Won-
Held. (2025). Surgical treatment for correction of rhizarthrosis: Systematic
review with meta-analysis. The American Journal of Medical Sciences and
PharmaceuticalResearch,7(03),157
–
164.
https://doi.org/10.37547/tajmspr/Volume07Issue03-16A
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Surgical treatment for
correction of rhizarthrosis:
Systematic review with
meta-analysis
Médica pela Universidade Salvador-UNIFACS, Salvador, BA, Brasil.
Andrey Santana Silva
Resident Doctor of Orthopedics and Traumatology at the Orthopedic
Hospital of the State of Bahia, Salvador, BA, Brazil.
Marina Lopes Cançado Campos
Orthopedic Surgeon and Traumatologist at Hospital Felício Rocho,
Belo Horizonte, MG, Brazil.
Flávio Henrique Loyola Santos
Orthopedic Surgeon and Traumatologist at the Royal Portuguese Hospital
of Pernambuco, Pernambuco, PE.
Arthur Vieira de Moraes Won-Held
Orthopedic Surgeon and Traumatologist at Hospital Santa Teresa,
Petrópolis, RJ, Brazil.
This study presents no conflicts of interest.
This study did not receive any financial support from
public, commercial, or non-profit sources.
Abstract:
Objectives:
to evaluate the results obtained from the
arthroplasty, arthrodesis and trapeziectomy with
tendon interposition techniques used to treat
rhizarthrosis.
Methodology:
This is a systematic review with meta-
analysis carried out by searching the electronic
databases PubMed/MEDLINE and Cochrane Library
without language restriction for publications up to June
2024 to analyze the surgical treatment of arthritis of the
first carpometacarpal joint.
Results:
289 patients were included, of whom 63
underwent trapeziectomy with tendon interposition,
70 underwent arthrodesis and 156 underwent
arthroplasty. Arthroplasty showed good long-term
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The American Journal of Medical Sciences and Pharmaceutical Research
results when compared to the most commonly used
techniques for correcting rhizarthrosis. Trapeziectomy
showed no significant improvement in strength or
functionality when compared to arthrodesis, and was
also more associated with cases of joint reduction
failure and consequent re-intervention.
Conclusion:
No surgical technique is superior to
another in terms of pain, physical function and the
patient's overall assessment.
Keywords:
Osteoarthritis; Hand; Metacarpal Bones;
Orthopedic Procedures
INTRODUCTION:
The inflammatory process of the first carpometacarpal
joint (between the trapezium and the first metacarpal),
called rhizarthrosis, is common in patients over 60
years of age, and its incidence and diagnosis have
increased with the aging population. It results from the
degeneration of the articular cartilage, mainly in
women due to hormonal factors, but it is also prevalent
in the male population and has diverse etiologies,
depending on the range of motion and the load to
which this joint is subjected in daily activities. ¹
The diagnosis is predominantly clinical and, when
necessary,
evaluation
and
submission
to
complementary
exams
such
as
radiography,
tomography and MRI. Regarding treatment, it is based
on the patient's response to conservative intervention,
since initially it is the majority of choice. However, in
patient’s
refractory to this approach, several surgical
procedure techniques are described in the literature
and bring effectiveness: trapeziectomy with or without
interposition, arthroplasty with interposition implant or
resurfacing, fusion (arthrodesis) and replacement
arthroplasty (prosthesis). ²
Compared to invasive options, trapeziectomy is
considered the gold standard and provides good pain
response, functionality and loss of residual strength.
Regarding the trapeziometacarpal prosthesis, the
durability of the implant is one of the main concerns,
however, performing it does not compromise any other
future surgical option. Secondary trapeziectomy after
arthroplasty generally does not differ from the results
of primary trapeziectomy and survival is 95.6% at four
years in a first prosthesis model tested, 93% and 85% in
two other models and 68% after five years in a fourth
model evaluated. 2,3,4,5,6,7
Arthroplasty has proven to be an effective alternative if
correctly indicated and performed. It can be concluded
that no procedure is superior in the long term in terms
of pain, physical function, assessment, range of motion
or strength. In other words, the superiority of
arthroplasty over other surgical procedures has not yet
been confirmed to date. 2,3,4 Therefore, the objective
of this study is to evaluate the results obtained through
the techniques of arthroplasty, trapeziometacarpal
arthrodesis (TMA) and trapeziectomy with tendon
interposition (LRTI) used for the treatment of
rhizarthrosis.
METHODOLOGY
Systematic review under registration in the prosperous
CRD42024538614 carried out according to the
recommendations of Khan et al considering: framing
the questions for a literature review; identifying
relevant research; assessing the quality of the studies;
summarizing the evidence and interpreting the results.
The research questions were defined by the PICOS
model according to the PRISMA guidelines, as follows:
1.
Population: Patients with arthritis of the first
carpometacarpal joint (Rhizarthrosis)
2.
Intervention: Surgical treatment
3.
Comparator:
Comparison
between
surgical
techniques for correction of arthritis of the first
carpometacarpal joint .
4.
Results: There was no superiority between the
techniques in terms of pain, physical function, or
overall patient assessment.
5.
Study design: Randomized controlled designs,
counterbalanced crossovers, or repeated measures
designs that investigated the effects of recovery
interval.
Database research carried out from March to May
2024, records from 3 electronic databases were
analyzed (Pubmed, Virtual Health Library BVS, Ebsco
Sportdiscus). The keywords were obtained using the
PubMed “mesh terms” qu
ery. The search was
conducted with the terms in English for: arthritis of the
first carpometacarpal joint with combination “AND”
orthopedic procedures.
Study selection
We included peer-reviewed, published, randomized
placebo-controlled clinical trials (RCTs) with full articles
investigating the efficacy of surgical techniques in the
treatment of rhizarthrosis. Taking into account the
diagnosis of osteoarthritis of the first carpometacarpal
joint with one of the following criteria: (1) studies
analyzing
arthrodesis,
arthroplasty,
and/or
trapeziectomy techniques with tendon interposition (2)
patients over 18 years of age (3) clinically and/or
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radiologically confirmed. Clinical trials were required to
report at least one of the following primary outcomes:
pain or physical function. Secondary outcomes included
adverse events (AEs), radiographic joint space
width/narrowing, stiffness, analgesic use, and quality of
life.
RESULTS
A total of 214 articles were superficially selected, and
after excluding those published more than 15 years
ago, 85 remained. Analysis of the titles and abstracts
resulted in the removal of 62 more studies, leaving 23
for full reading. After analyzing the articles, those that
evaluated other types of treatment, such as
conservative treatment, for rhizarthrosis were
excluded. In the end, four articles that fit the proposed
methodology were selected for construction of the
work (Figure 1).
Figure 1- PRISMA protocol and study selection
Source: Own authorship (2024)
The four articles analyzed correspond to patients
diagnosed with trapeziometacarpal osteoarthritis
(rhizarthrosis) who underwent surgical treatment. Two
articles compared the techniques of arthrodesis and
trapeziectomy with tendon interposition, one analyzed
arthroplasty, and the other article compared the
techniques
of
arthrodesis,
arthroplasty,
and
trapeziectomy with tendon interposition. A total of 289
patients were included, of whom 63 underwent
trapeziectomy
with
tendon
interposition,
70
underwent
arthrodesis,
and
156
underwent
arthroplasty.
Figure 2 shows the Eaton and Littler Classification.
10,11,12,13
Figure 2- Eaton and Littler classification.
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Stage 1 - Normal radiograph or slight increase in space
Stage 2 - Flattening of the articular cartilage, osteophytes or free div smaller
than 2 mm. Normal scaphotrapezoid joint.
Stage 3 - Joint impingement, subchondral sclerosis, osteophytes larger than 2
mm. Normal scaphotrapezoid joint.
Stage 4 - Involvement of both trapeziometacarpal and scaphotrapezoid joints
Table 1 represents the Eaton and Littler classification of the patients included in the study. 10,11,12,13
Table 1- Eaton and Littler classification of patients included in the study.
Study
Stage I
Stage II Stage III
Stage IV
Unknown
Vermeulen et
al.
0
34.2%
65%
0
0
Pritchett et al.
0
50%
50%
0
0
Hippensteel et
al.
0
14%
64%
7.4%
14.6%
Raven et al.
5.2%
47.3%
36.5%
11%
0
Table 2 presents the postoperative DASH score of
surgical procedures for the treatment of osteoarthritis
of the trapeziometacarpal joint. 10,11,12,13
Table 2- DASH score (Disabilities of the Arm, Shoulder and Hand) and pain analogue scale (VAS) postoperative
period of surgical procedures for the treatment of osteoarthritis of the trapeziometacarpal joint
Study
Sample
Arthrodes
is
Trapeziectomy
LRTI
Arthroplasty
Scale
Vermeulen et
al.
38 patients 33.9+-2.1
31.5+-33
-
DASH
SCORE
Vermeulen et
al.
38 patient
19.9+-3.9
16+-2.7
-
Analogue
pain scale
(VAS)
Hippensteel et
al.
50 patients
14+-15
31+-19
-
DASH
SCORE
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Hippensteel et
al.
50 patients
29+-24
38+-20
-
Analogue
pain scale
(VAS)
Raven et al.
63 patients
25+-15
27+-16
26+-15
DASH
SCORE
Raven et al.
63 patient
23+-10
10+-10
4+-10
Analogue
pain scale
(VAS)
Figure 3 shows the Forest plot with the DASH score
(Disabilities of the Arm, Shoulder and Hand) of the
selected studies. 10,11,12,13
Figure 3- Forest graph with the DASH score (Disabilities of the Arm, Shoulder and Hand) of the selected
studies.
The randomized study by Vermeulen et al evaluated the
use of arthrodesis using plate and screw compared to
trapeziectomy with ligament reconstruction and
tendon interposition (LRTI) in the treatment of
osteoarthritis of the trapeziometacarpal joint. Twenty-
one patients underwent trapeziectomy and LRTI and
another 17 underwent arthrodesis. Of these, 13 were
in the Eaton Littler stage II classification and 25 in stage
III. The PRWE (Patient-Rated Wrist Evaluation Score) for
assessing pain and functionality showed a preoperative
value of 33.9 ± 2.1 versus 21 ± 2.5 and 16 ± 2.7 after 03
and 12 months, respectively, after trapeziectomy and
LRTI. For the arthrodesis group, the baseline value was
39.5 +/- 1.7 versus 19.7 +/- 3.7 and 19.9 +/- 3.9 after 03
and 12 months of the procedure. The DASH score of
group 1, submitted to trapeziectomy and LRTI, was 44.3
+/- 3.3 before the procedure and 31.5 +/- 3.3 and 20.6
+/- 3.0 after 03 and 12 months. In the arthrodesis
group, the preoperative DASH values were 33.9 +/- 2.1
versus 33.9 +/- 2.2 after 03 months; this value was
maintained during the year of study. The range of
motion was also analyzed preoperatively, after 03 and
12 months of the procedures, such values were:
trapeziectomy and LRTI group, preoperative flexion of
the metacarpophalangeal joint 45.3º + -3.8 versus 34.0
° + -2.4 and 37.9 ° + -2.3 during the period. While the
extension of the same joint was -6.7 ° + - 3.1 versus -
15.6 + -2.9 and -16.1 ++ 2.8. The arthrodesis group
presented preoperative flexion of the
metacarpophalangeal joint of 50.1 ° + -2.4, 41.3 ° + -1.9
and 42.4 ° 4.2 during the study period. The extension of
the same joint -7.2 + -4.1 before the procedure and -
16.7 ° + -2.8 and -19.3 ° + -4.1 after it. Regarding the
complications reported, 06 were associated with
trapeziectomy in the LRTI group (three mild and three
moderate), such as sensory disturbances and
tendonitis, compared to 15 complications (six mild, six
moderate and three severe) in the arthrodesis group.
10
The study by Pritchett et al evaluated the use of
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hemiarthroplasty in the treatment of osteoarthritis of
the trapezometacarpal joint. All 138 patients (159
arthroplasties) in the study underwent the procedure
and presented Eaton Littler stages II and III alterations.
According to the Buck Gramcko score, used for
functional evaluation, 57 thumbs performed more than
40° of palmar abduction, 75 with abduction between
30º-39º and 11 of 20º-29º, no data were recorded for
limitation of movement at a value less than 20º. For
radial abduction, 54 thumbs performed abduction
greater than 40°, 80 between 30° and 39°, 9 between
20° and 29º. In the pinch movement performed
compared to the contralateral side, only one thumb
performed 100% of the function, 35 performed
between 80%-99%, 106 performed between 60-79%
and only one performed less than 60%. Some subjective
results were evaluated, 66 patients reported never
feeling pain after the procedure, 75 felt it sometimes
and only two reported feeling it constantly. And, in
relation to the execution of daily functions, 107
performed it without difficulty and only 36 presented
some type of difficulty. 139 reported that they would
do the procedure again and only four reported that
they would not do it again. The complications
associated with the procedure were an intraoperative
fracture, a painful neuroma and one case of infection.
One patient had numbness in the region of the radial
nerve and one case of arthritis in another part of the
hand. 11
The study by Hippensteel et al evaluated the use of
trapeziometacarpal arthrodesis (TMA) compared to
trapeziectomy with ligament reconstruction and
tendon interposition (LRTI). A total of 50 patients were
evaluated, of which 25 underwent TMA and the other
25 LRTI. In the TMA group, 22% of the patients were in
stage II of the Eaton Littler classification, 66% in stage
III and 3.7% in stage IV. The LRTI group had 8% in group
II, 64% in group III and 12% in group IV. The
preoperative DASH, an upper limb functional
assessment scale, was 36±15° in the TMA group and
14±15° after the procedure, in the LRTI group the initial
value was 52±19° versus 31±19° postoperatively. The
preoperative Sollerman functional test in the TMA
group was 72±7 and 77±7 after the procedure, for LRTI
the values were 68±9 before surgery and 74±9 after.
The VAS score for pain assessment was 50±24
preoperatively and 29±24 after the procedure in the
TMA group, for the LRTI group, the preoperative value
was 56±20 and 38±20 postoperatively. When
comparing thumb movement between the two groups,
TMA was related to a significantly greater improvement
than LRTI (P<0.05). Regarding complications, they were
similar between the groups, however, revision
surgeries were frequent after TMA. The most frequent
complication associated with LRTI was paresthesia,
while TMA was associated with more cases of failure in
joint reduction. 12
In the study by Ravel et al, 63 patients diagnosed with
osteoarthritis of the trapezometacarpal joint were
treated surgically, 18 were treated with resection
arthroplasty, 17 with trapeziectomy and tendon
interposition, and 28 with trapezometacarpal
arthrodesis. In group one, which underwent resection
arthroplasty, 44% of patients reported never feeling
pain after the procedure and only 6% reported feeling
pain daily. When compared to preoperative pain, 89%
reported feeling significantly better. The VAS scale for
pain, in the same group, was 4 (p=0.02), the DASH score
was 26, and the postoperative radial abduction was
45°. In group two, in which patients underwent
trapeziectomy, 59% of patients reported never feeling
postoperative pain, 94% reported significantly
improved preoperative symptoms, the VAS scale was
10 (p=0.02), the DASH score was 27 and the
postoperative radial abduction was 64°. Finally, in
group 3, which underwent arthrodesis, only 29%
reported never having felt postoperative pain, 71%
stated that they were significantly improved, the VAS
score was 23, the DASH score was 25, and the
postoperative radial abduction was 50°. Regarding the
complications found in each group, in the group
undergoing trapeziectomy, four (24%) thumbs had
sensory alterations resulting from damage to the
terminal branches of the radial nerve. One patient had
Sudeck's dystrophy and there were no reoperations
due to complications. The group undergoing resection
arthroplasty was associated with a sensory deficit due
to damage to the terminal branches of the radial nerve
in two thumbs (11%). 13
DISCUSSION
Several surgical procedures have been described for
the
treatment
of
rhizarthrosis
and
include:
arthroplasty, arthrodesis and trapeziectomy with
tendon interposition. If conservative treatment fails,
surgical intervention usually yields good results and
leads to patient satisfaction, regardless of the
technique used. 13, 14
Arthroplasty is a simpler procedure that has also shown
good long-term results when compared to the most
commonly used techniques of trapeziectomy combined
with tendon interposition and arthrodesis. When
compared to LRTI, TMA did not show significant
improvement in strength or functionality, and is also
more associated with cases of joint reduction failure
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and consequent reintervention. 10,11,12,13
For the surgical technique of resection arthroplasty, the
joint is approached through a straight radial incision
over the first metacarpal and the trapezium up to the
wrist. Then, after the joint is exposed, the articular
surfaces of the trapezium and the metacarpal bone are
removed, taking care to resect all osteophytes. The
postoperative period consists of two weeks of
immobilization with a splint on the forearm followed by
functional treatment. 13
Arthrodesis of the trapeziometacarpal joint has been
shown to be a reliable procedure with good long-term
results. This technique is approached in a manner
similar to arthroplasty, and the articular cartilage and
adjacent sclerotic subchondral bone are removed. A
small laminar spreader is placed to achieve lengthening
and correction of adduction. However, this surgery
often results in complaints of pain due to the thin skin
overlying the hardware, resulting in a high rate of
reintervention. 13
Trapeziectomy is a quick and easy procedure that is
usually the one chosen for the treatment of
rhizarthrosis. Briefly, trapeziectomy is performed by
removing the trapezium through a dorsoradial incision,
releasing the first extensor compartment. Then, a strip
of the distal base of the abductor pollicis longus is
passed through a slit in the flexor carpi radialis and then
sutured to itself to form a suspensory support. In this
way, the rest of the tendon is placed in the
trapeziectomy space. Therefore, in this technique, to
overcome problems of instability and shortening, the
interposition of a flexor carpi radialis tendon rolled into
the space of the removed trapezium was introduced.
This surgery leads to better pain reduction and
functional outcome. 13, 14, 15
Research shows that no evidence of superiority
between the techniques has been demonstrated,
despite some differences in terms of complications.
Arthroplasty has good long-term results when
compared to trapeziectomy and arthrodesis, and it also
has fewer complications and interventions compared
to arthrodesis. In contrast to trapeziectomy,
arthrodesis has a higher frequency of problems and
surgical reintervention. Even though the procedures
have small differences in terms of complications, no
surgical technique is superior to the other in terms of
pain, physical function, patient global assessment,
strength or range of motion. 13, 14
CONCLUSION
Trapeziectomy is the most commonly used procedure
for treating rhizarthrosis. However, the studies
analyzed also demonstrated good results with
arthroplasty as the intervention of choice, which is also
associated with lower rates of complications and
surgical reinterventions. Although the procedures
presented some differences in terms of complications,
no surgical technique is superior to another in terms of
pain, physical function, and overall patient assessment.
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