Surgical and non-surgical management of rhizarthrosis: A systematic review of diagnostic approaches, pain control, and functional outcomes

Abstract

Objective: To synthesize and critically evaluate recent evidence regarding the diagnosis, treatment strategies, pain management, and functional outcomes in patients with rhizarthrosis, with a focus on surgical innovations and emerging conservative modalities. Methodology: A systematic review was conducted following PRISMA guidelines, covering publications from January 2020 to April 2025. Databases searched included PubMed, Scopus, Web of Science, and Embase, using Boolean combinations of relevant keywords related to trapeziometacarpal osteoarthritis. Inclusion criteria encompassed original clinical studies, systematic reviews, and meta-analyses focusing on adults diagnosed with rhizarthrosis. Quality assessment tools appropriate to each study design were applied. Data synthesis was performed narratively due to heterogeneity in methodologies and outcomes. Results: A total of 30 studies were included. Diagnostic accuracy remains largely dependent on clinical evaluation and radiographic staging (Eaton-Littler classification). Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) remains the gold standard in advanced cases, though prosthetic arthroplasty with Touch® and Arpe® implants demonstrates promising long-term results. WALANT techniques facilitated intraoperative functional assessment and reduced perioperative morbidity. Conservative modalities, including ESWT, showed potential in early-stage pain control. Functional outcomes improved significantly across surgical techniques, especially in DASH and PRWHE scores. However, no single procedure proved universally superior. Conclusion: Management of rhizarthrosis requires individualized decision-making based on disease severity, anatomical factors, functional demand, and patient context. Both surgical and non-surgical modalities offer substantial benefits, with evolving techniques such as WALANT and ESWT broadening the therapeutic arsenal. Further high-quality studies are needed to establish long-term comparative effectiveness.