A Changing Landscape in Surgical Treatment of Basilar Thumb Arthritis: Is the Rate of Denervation Increasing?

Purpose: The purpose of this study was to assess the evolving landscape of surgical interventions for basilar thumb arthritis. Methods: Using a national insurance claims database spanning from 2016 to 2022, patients undergoing surgical treatment for thumb carpometacarpal (CMC) arthritis were identified through International Classification of Disease 10 and Current Procedural Terminology codes. The incidence of each type of surgical procedure was collected and normalized to the 2016 level. The total percentage change in incidence and linear regression trendline was calculated over the 7-year period. Multiple variable logistic regression assessed factors associated with thumb CMC denervation. Results: Among 64,281 surgically treated patients, trapeziectomy with interposition arthroplasty was the most common (83.8%). Although thumb CMC denervation was the least common surgery and accounted for only 1.0% of all surgery, the incidence of denervation increased over the study period from 0.47 to 1.30 per 1,000,000, alongside a 41% rise in trapeziectomy alone. Regression analysis revealed male sex, Western US region, and concomitant carpal tunnel syndrome as associated factors for thumb CMC denervation. Conclusions: The study indicates a notable shift in surgical approaches for basilar thumb arthritis. Although CMC denervation was the least commonly performed basal joint surgery, there was an increase in denervation procedures from 2016 to 2022. Denervation was not associated with patient age and was most strongly associated with male sex. Type of study/level of evidence: Therapeutic IV.