Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alexandra N Krez; Kevin A Wu; Kevin M Klifto; Tyler S Pidgeon; Christopher S Klifto; David S Ruch

doi:10.1016/j.jhsa.2024.02.001

Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

J Hand Surg Am. 2024 Mar 26:S0363-5023(24)00055-8. doi: 10.1016/j.jhsa.2024.02.001. Online ahead of print.

Authors

Alexandra N Krez¹, Kevin A Wu¹, Kevin M Klifto², Tyler S Pidgeon¹, Christopher S Klifto¹, David S Ruch³

Affiliations

¹ Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri, Columbia, MO.
³ Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC. Electronic address: d.ruch@duke.edu.

PMID: 38530683
DOI: 10.1016/j.jhsa.2024.02.001

Abstract

Purpose: As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA.

Methods: A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded.

Results: The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma.

Conclusions: Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA.

Type of study/level of evidence: Therapeutic II.

Keywords: Carpometacarpal; corticosteroid; intra-articular injection; meta-analysis; osteoarthritis; trapeziometacarpal joint.