WHAT IS THE SCOOTT TRIAL?

Osteoarthritis at the joint at the base of the thumb (BTOA) affects 21% of people over the age of 40 and 46% of people over the age of 80 years. It affects a person’s ability to work, to be independent, to care for others and mental wellbeing. Those seeking treatment suffer severe pain, and difficulty in completing simple everyday tasks. 

 

There are a variety of non-surgical and surgical treatments available for BTOA. Non-surgical management can involve painkillers, anti-inflammatory medicines, splints, steroid injections and exercise, which can effectively reduce pain and prevent the need for surgery. However many patients are not given the initial opportunity to fully receive these treatments both consistently and comprehensively. If pain does not improve, patients are usually referred to a hand surgeon to consider surgery.

 

 Surgical options such as trapeziectomy (the current gold standard treatment) and carpometacarpal joint replacement (CMCJR; a less frequently used treatment with emerging evidence suggesting that it could improve patient outcomes and reduce recovery time) can be offered. Trapeziectomy involves the removal of the trapezium bone from the hand, while CMCJR involves the replacement of the carpometacarpal joint with a prosthesis.

 

There is a lack of high-quality evidence comparing surgical and non-surgical treatments and therefore a need for robust clinical trials to determine the best treatments for patients and to help guide UK clinical practice.

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Subsequently, we want to find out which is the best treatment for BTOA by comparing these three treatments (non-surgical treatment, trapeziectomy and joint replacement) in a fair way, through a randomised trial.

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Funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, researchers from York Trials Unit will work in collaboration with South Tees Hospitals NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust and the University of Nottingham.

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