A Comparative Analysis of Surgical Treatment for First Carpometacarpal Osteoarthritis: A Systematic Review and Pooled Analysis of Randomised Controlled Trials
Hand · 12 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Trapeziectomy-based procedures are the classic operation for thumb CMC arthritis, and dual-mobility prostheses are a newer option that may speed early recovery, but any long-term trade-off in revision risk remains unknown.
The evidence
This review pooled 7 randomised trials (409 hands) of surgery for thumb base (first carpometacarpal) arthritis and grouped the treatment arms into soft-tissue reconstruction (such as LRTI), trapeziectomy without reconstruction, and dual-mobility joint replacement. At 3 months the implant arms had the largest average drop in VAS pain (about 6.05 points, versus 3.52 for reconstruction and 2.86 for non-reconstruction). By 12 months pain improvement was similar across groups (5.98 to 6.54 points). These were descriptive within-group averages, not formal between-group comparisons.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Systematic reviewDesign starting point: 50.4
Raised the score
- Pools randomised trials+5.1
- Compared against current standard of care+3.4
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedNot met
- Study exclusions justifiedMet
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 50.4
- Compared against current standard of care
- +3.4
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Final rigour score rounded
- 70 / 100
Study design sets the starting point and a ceiling of 88. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a 60-year-old manual worker with Eaton stage III thumb CMC arthritis, how would you weigh a possibly faster early recovery with a dual-mobility implant against the proven long-term durability of trapeziectomy with or without LRTI?
2.How should you counsel a patient choosing simple trapeziectomy about the expected temporary dip in grip strength in the first 3 months and the likely similar pain relief by 1 year?
Original publication title
A Comparative Analysis of Surgical Treatment for First Carpometacarpal Osteoarthritis: A Systematic Review and Pooled Analysis of Randomized Controlled Trials