Rééducation après arthroplastie prothétique de l’articulation interphalangienne proximale des doigts longs

Abstract

PIP joint arthroplasty still remains an unsolved biomechanical challenge despite material advancements and new implant designs. This leads to a relatively high rate of complications. On the other hand, there is heterogeneity in postoperative management in the current literature. The present structured review aimed to examine the therapeutic strategies that could be used by the physiotherapist in order to help the patient recover a functional finger chain and prevent postoperative complications following PIP joint replacement. This review focused on patients undergoing primary total PIP joint arthroplasty of index, ring, middle and little fingers. Hand function and postoperative complications were the two variables studied. Therapeutic strategies were organized according to the parameters representing these variables. Literature searches were conducted between September 2018 and April 2019 on PUBMED. Research published from 2008 onwards, in French and English and reporting on PIP joint replacement and postoperative management were included. Details of surgical approaches, splint strategies, mobilization and strengthening and management of postoperative complications were recorded. In total, 48 studies including 3 articles providing description of surgical techniques were included. One study was found that mainly focused on rehabilitation strategies following PIP joint replacement. Nevertheless, in relation to hand function, most authors advocated joint mobilizations (n = 45) and some recommended strengthening (n = 4). Static (n = 43) and dynamic splints (n = 14) as well as buddy taping (n = 12) were frequently recommended to prevent and also to manage postoperative complications. On the other hand, few studies (n = 13) reported on wound assessment and postoperative swelling control. It is not possible to provide precise recommendations concerning therapeutic strategies that need to be adopted following PIP joint arthroplasty based on available knowledge. This is due to a lack of information on postoperative management and the use of different parameters in studies. Actual postoperative protocols do not allow the hand therapist to reproduce them in clinical practice. Hand function and complications following PIP arthroplasty might be influenced by the postoperative management therefore the methodological quality of studies might be questionable due to the lack of detail regarding postoperative protocols. Joint mobilization is one of the essential strategies in the postoperative management of PIP joint. However, specific protocols for rehabilitation following PIP joint replacement need to be clarified in future research. Hand and wrist musculoskeletal models could help surgeons and hand therapists in their clinical decisions in relation to surgical and therapeutic management.