Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review.

Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a research agenda. A systematic literature search was performed up to September 2022. Two investigators independently identified studies that reported on denervation for OA of the proximal interphalangeal, distal interphalangeal, metacarpophalangeal or carpometacarpal joints. Quality of studies was assessed and study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted. Of 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. Sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. One non-randomised clinical trial reported no difference in outcome when comparing denervation of the first carpometacarpal (CMC I) joint to trapeziectomy. Adverse events were frequent, with sensory abnormalities occurring the most, followed by the need for revision surgery. All studies had significant risk of bias. Surgical denervation for pain in hand OA shows some promise, but the available evidence does not allow any conclusions of efficacy and higher-quality research is needed. Techniques should be harmonised and more data regarding how denervation compares to current usual care, other denervation methods or placebo in terms of outcomes and adverse events are needed.

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Déclaration de conflit d'intérêts

Competing interests: MK reports the following, all outside the current study: Grants from IMI-APPROACH and the Dutch Arthritis Society, paid to the institution. Royalties or licences from Wolters Kluwer and Springer Verlag, paid to the institution. Fees for consulting/advisory boards by Abbvie, Kiniksa, Galapagos, CHDR, Novartis, UCB, all paid to the institution. Payment or honoraria for lectures or presentations from Galapagos and Jansen, paid to the institution. Roles on the OARSI board (member), EULAR council (member advocacy committee EULAR) and presidency of the Dutch Society for Rheumatology. For the current study, MK reports funding from SKMS, paid to the institution.