Network Meta-analysis Of Different Surgical Treatments For The Carpometacarpal Arthritis

Objective: The purpose of this study is to comprehensively assess the clinical outcomes and the postoperative complications of trapeziometacarpal arthrodesis,trapeziectomy,Trapeziectomy with ligament reconstruction and/or tendon interposition,Prosthesis insertion arthroplasty,Spherical fossa Prosthesis Arthroplasty for patients with Carpometacarpal arthritis using the combination of traditional meta-analysis and network meta-analysis.The probabilities of each intervention were ranked,and further analyzed to evaluate the advantages and disadvantages of these procedures.Provide evidence support for clinicians to treat first palmar arthritis,and provide reference for clinical practice decision-making.Methods: PubMed,Embase and Cochrane Library were searched for the randomized controlled trials or nonrandomized controlled trials concerning comparison of different surgical treatment options for Carpometacarpal arthritis.The following outcome measures were extracted:Visual Analog Scale(VAS score),Disabilites of the arm shoulder and hand(DASH score),Radial abduction,Palmar abduction,Grip strength,pinch force,The effective mobility score of the carpometacarpal joint(Kapandji score),The distance between the base of the thumb metacarpal and the scaphoid(SMD)and postoperative complications.Data analysis was conducted on STATA 15.1 software.Result: Of the1449 relevant literatures,27 studies met inclusion criteria with 2115 patients.fourteen were at high risk of bias,and rest were classified as unclear risk of bias.Network meta-analysis showed that there was no statistically significant difference in indirect pairwise comparison among the postoperative VAS score,postoperative DASH score,postoperative Radial abduction,postoperative Palmar abduction,and postoperative SMD of twenty-seven studies.The postoperative pinch force of six interventions except for LRTI and AAI included in thirteen studies.Network meta-analysis showed that there was statistically significant difference in which the postoperative pinch force of SPA was bigger than the other five interventions except for AAI.The pairwise direct comparison that the postoperative pinch force of SPA was bigger than LRTI of witch was statistically significant.The postoperative Kapandji score of seven interventions except for AAI included in eight studies.Network meta-analysis showed that there was statistically significant difference in whichthe effective mobility score of the carpometacarpal joint of SPA was better than the other six interventions.The direct pairwise comparison that the Kapandji scores of LRTI was better than TMA of witch was statistically significant.The postoperative complications of seven interventions except for AAI included in twenty studies.Network meta-analysis showed that there was statistically significant difference in which the postoperative complication rate of T was less than the other five interventions except for LR,the postoperative complication rate of TMA was highter than the other six interventions,the postoperative complication rate of PCPA was highter than the other five interventions except for TMA,the postoperative complication rate of LRTI was highter than TI.The direct pairwise comparison that the postoperative complication rate of T was less than LRTI and PCPA of witch was statistically significant.Conclusions:1.There was no significant difference in postoperative VAS score,postoperative DASH score,postoperative Radial abduction,postoperative Palmar abduction,postoperative Grip strength and postoperative SMD.2.Among the eight interventions,Spherical fossa Prosthesis Arthroplasty was better than other procedures in terms of postoperative pinch force and postoperative effective activity.3.The incidence of postoperative complications of trapeziectomy was significantly less than that of other procedures.4.The incidence of postoperative complications of Pyrolytic Carbon Prosthesis Arthroplasty and trapeziometacarpal arthrodesis was significantly higher than other procedures.5.There is no evidence to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function.