What is the most effective treatment for basal osteoarthritis of the thumb?

Abstract

Basal osteoarthritis of the thumb is extremely common and causes pain and difficulty with essential 'pinching' tasks such as writing and dressing. It has been shown, in high-quality studies, that physiotherapy can result in clinically important improvements in pain and function, but the delivery of nonoperative treatment currently varies considerably throughout the NHS in the UK. Trapeziectomy is an effective, simple, and low-cost procedure, and the most common of surgical treatment for basal osteoarthritis of the thumb in the UK. However, recovery can be lengthy and complications include subsidence of the thumb metacarpal, instability, and weakness. New designs of thumb carpometacarpal joint arthroplasty (CMCJA) show promising early results with low complication rates and a quick return to function, but the implants are expensive and high-quality evidence about the outcome is lacking. The Surgery versus Conservative OsteOarthritis of Thumb Trial (SCOOTT) is a multicentre, three-arm, randomized controlled trial which is currently being undertaken, comparing the clinical outcomes and cost-effectiveness of an enhanced package of non-surgical management, trapeziectomy, and thumb CMCJA.