gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

Meeting Abstract

  • presenting/speaker Benjamin Dean - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Martinique Vella Baldacchino - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Neal Thurley - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Nicholas Riley - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Christopher Little - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Sally Hopewell - NDORMS, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
  • Andrew Carr - NDORMS, University of Oxford, Botnar Research Centre, Oxford, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-163

doi: 10.3205/19ifssh0947, urn:nbn:de:0183-19ifssh09473

Published: February 6, 2020

© 2020 Dean et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: To evaluate the effectiveness of injection based therapy in base of thumb osteoarthritis.

Methods: Design: Systematic review and meta-analysis.

Data sources: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO were searched from database inception to 22nd May 2018.

Study selection: Randomised controlled clinical trials (RCTs) of adults with base of thumb osteoarthritis investigating an injection based intervention with a comparator.

Data extraction and analysis: Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points.

Results and Conclusions: In total, nine RCTs involving 504 patients were identified for inclusion after screening. All these studies compared different injection based therapies with each other, while no prospective study comparing an injection based therapy with a non injection based intervention was identified. Twenty injection based intervention groups were present within these nine trials, consisting of hyaluronic acid (9), corticosteroid (7), saline placebo (3) and dextrose (1). Only limited meta-analysis was possible due to the heterogeneity in the injections and outcomes used, as well as incomplete outcome data. Meta-analysis of two studies (92 patients) demonstrated no statistically significant difference in pain or function with corticosteroid versus hyaluronic acid in the short and medium term. Overall the available evidence does not suggest that any of the commonly used injection therapies are superior to placebo, one another or a non-injection based comparator.

Current evidence is equivocal regarding the use of injection therapy in base of thumb osteoarthritis, both in terms of which injection based therapy is the most effective and in terms of whether any injection based therapy is more effective than other non injection based interventions. Given limited understanding of both the short and longer term effects, there is a need for large, methodologically robust multicentre RCTs investigating the commonly used injection therapies.