POS1359 SURGICAL DENERVATION TO TREAT PAIN IN HAND OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

<h3>Background</h3> Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). <h3>Objectives</h3> We performed a systematic literature review to summarize the available evidence and propose a research agenda. <h3>Methods</h3> A systematic literature search was performed up to September 2022. Two investigators identified studies that reported on denervation for OA of the proximal interphalangeal joint (PIPJ), distal interphalangeal joint (DIPJ), metacarpophalangeal joint (MCPJ) or first carpometacarpal joint (CMCJ). Reviews, comments, letters or editorials, studies in languages other than English and studies investigating other interventions, joints or conditions were excluded. Quality of studies was assessed with the Joanna Briggs Institute checklist for case series and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I), where applicable. Study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted. Due to the nature of the data, no meta-analysis was performed. Data from the studies were pooled and minimal and maximal scores were estimated. <h3>Results</h3> The search yielded 212 articles from the Pubmed, OVID and Cochrane databases. From these, 17 articles (reporting on 384 denervation surgeries in 351 patients) were selected. Twelve studies described CMCJ denervation, three described PIPJ denervation, and the others described DIPJ (n=1), MCPJ (n=1) or a mixture of MPCJ, PIPJ and DIPJ denervation (n=1). The surgical techniques varied greatly, both in incisions and in the nerves severed, even between studies investigating denervation of the same joint. The innervation of the joints in the hand is still subject to debate. Most of the studies were case series (n=16), and one was a non-randomized clinical trial. Sample size ranged from 3 to 60 participants. All studies had significant risk of bias. The studies consisted of patient groups with average age ranging from 55 to 65 and 60-75% female participants. The sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. Average pain decrease ranged from 3 to 8.1 on a 10-point numeric rating scale (NRS) (n=8 studies), with a 56-92% patient satisfaction rate (n=5) and mean increase in range of motion of 3.5-27 degrees (n=3). The non-randomized clinical trial reported no differences in outcome when comparing denervation to trapeziectomy. Adverse event rates ranged from 0-75% of denervation procedures. Sensory abnormalities occurred most, followed by the need for revision surgery and infections of the area of the surgery. <h3>Conclusion</h3> Surgical denervation for pain in hand OA shows promise, but the available evidence does not allow conclusions, as for example regression to the mean can strongly influence the observations in case series. More and higher quality evidence is needed before it can be recommended as part of standard care. On the research agenda are 1) the innervation of the joints, 2) the best surgical technique to sever all relevant nerves, and 3) perform high-quality randomized clinical trials to investigate the efficacy of surgical denervation in comparison to sham, 4) to investigate other interventions targeted at the innervating nerves, and finally 5) the safety of the different surgical denervation techniques. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.