gms | German Medical Science

Objectives/Interrogation: We explored the prevailing surgical procedures and ultimate last resort surgical management for isolated carpometacarpal (CMC-1) osteoarthritis (OA) among hand surgeons in Europe.

Methods: An online survey was distributed to hand surgeons of participating member states of the Federation of European Societies for Surgery of the Hand. Respondents were asked about the country of practice, years of surgical experience, preferred surgical procedures for isolated CMC-1 OA, the last resort procedure if all other surgical procedures have failed, and considerations for choosing this particular procedure as last resort. Statistical analysis of correlations between demographic and treatment data was performed using Pearson chi-square test.

Results and Conclusions: We received 444 replies across Europe, representing an estimated response rate of 18%. Trapeziectomy with ligament reconstruction and tendon interposition was opted by 46% of the respondents as a procedure of first choice, followed by prosthetic joint replacement (25%) and trapeziectomy with interpositional arthroplasty (23%). Several differences in the choice of preferred surgical treatment between the countries of practice, and between junior and senior surgeons were found to be statistically significant. Regarding the ultimate last resort surgical procedure, 36% chose suspensionplasty, followed by trapeziectomy with or without complementary procedure (21%) and arthrodesis between the base of the first and second metacarpal (17%).

This is the first European-wide study providing insight in the prevailing surgical management for isolated CMC-1 OA. The current surgical practice for isolated CMC-1 OA is still largely based on experts' experience and local tradition, rather than on evidence. Future prospective randomized studies comparing different techniques for (failed) CMC-1 surgery may help in validating one surgical procedure over another.