Early Mobilization After Basal Joint Arthroplasty: Preliminary Clinical Results: Level 2 Evidence

Abstract

There is no financial information to disclose. Traditional rehabilitation for basal joint arthroplasty involves prolonged thumb immobilization prior to initiating motion and strengthening. We hypothesize that early motion following basal joint arthroplasty is safe and will result in equivalent clinical outcomes to traditional rehabilitation. Patients undergoing ligament reconstruction and tendon interposition (LRTI) were randomized to 1 of 2 rehabilitation protocols. All patients were immobilized following surgery in a thumb-spica plaster splint for 2 weeks. The accelerated rehabilitation group (Group 1) was then transitioned into a removable neoprene thumb CMC-wrap with activity as tolerated, while the traditional rehabilitation group (Group 2) were placed in a thumb-spica cast or splint to be worn full-time for an additional 4 weeks. Patients were examined pre-operatively and at 6 and 12-weeks post-operatively. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analog scale for pain (VAS), pinch and grip strength and thumb range of motion. A descriptive analysis was run on data for both groups along with a repeated measure analysis of variance to compare the 2 groups at each time point with significance set at P < 0.05. Twenty seven patients were randomized, 13 in Group 1 and 14 in Group 2. There were no statically significant differences between the two groups with respect to age, preoperative DASH, VAS, pinch or grip strength or thumb CMC range of motion. There were no statistically significant difference between the 2 groups with respect to post-operative DASH, VAS, pinch or grip strength or thumb range of motion at both six and 12 weeks post-operatively. All pre-operative and 12-week post-operative outcomes data are presented in Tables 1 and 2 respectively. There were no intraoperative complications. •Early (12-week) outcomes suggest that early mobilization of patients following CMC arthroplasty does not compromise clinical results, with no significant difference demonstrated in DASH, VAS score, thumb strength or range of motion.•Longer term data and increased sample size will determine the lasting effects of accelerated rehabilitation•An accelerated rehabilitation protocol may offer equivalent clinical results with earlier return to pre-morbid function than traditional rehabilitation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)