To the Editor: Wong et al1 performed a thorough and detailed study of the cost-effectiveness of 2 surgical procedures for patients with trapeziometacarpal arthritis and found that trapeziectomy and suture suspension arthroplasty is a cost-effective alternative to trapeziectomy with ligament reconstruction and tendon interposition. The authors explained that economic evaluations are essential given rising healthcare costs and the shift toward value-based care. They noted that traditional studies do not provide a comprehensive cost-effectiveness comparison of surgical options. Although Wong et al1 did not evaluate the cost-effectiveness of trapeziectomy alone, they referenced a study that did.2 Yoon et al2 reported that trapeziectomy alone was more cost-effective than trapeziectomy with ligament reconstruction and tendon interposition and concluded that it “should be considered as first-line surgical treatment.” If trapeziectomy alone and trapeziectomy with suture suspension arthroplasty are more cost-effective than trapeziectomy with ligament reconstruction, one might wonder which of these (trapeziectomy alone versus trapeziectomy with suture suspension arthroplasty) is more cost-effective. A frequent rationale for suture suspension arthroplasty, as well as for ligament reconstruction and tendon interposition, is the maintenance of trapezial height and the prevention of subsidence of the thumb metacarpal. However, as Wong et al are certainly aware, subsidence is not associated with pain.3 Liu et al4 performed a systematic review and meta-analysis comparing simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition and found no statistical difference in key pinch strength, pain relief, and Disabilities of the Arm, Shoulder, and Hand scores. Ligament reconstruction and tendon interposition were associated with more iatrogenic injury, more short-term postoperative complications, and high surgical cost. Trapeziectomy alone for trapeziometacarpal arthritis has a long and successful history. It was described more than 75 years ago by Gervis,5 who recommended that “active movements are started at once” after surgery. There is no gold standard surgical treatment for painful osteoarthritis of the trapeziometacarpal joint. Authors have noted that the choice of surgical treatment is controversial.1,4 Nonetheless, trapeziectomy alone has stood the test of time, and perhaps it is against this procedure that new procedures should be measured. DISCLOSURE The author has no financial interest to declare in relation to the content of this article.
Stuart H. Kuschner (Mon,) studied this question.