AAOS2017: Early mobilization vs. immobilization after basal joint arthroplasty

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
27 patients scheduled for ligament reconstruction and tendon interposition of the carpometacarpal joint were randomized to either mobilization after 2 weeks, or continued immobilization for 6 weeks to determine if early mobilization is safe and effective in this population. Patients were followed up at 6 and 12 weeks postoperatively for patient-reported function, pain, pinch and grip strength, and range of motion. No significant differences Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Ligament reconstruction and tendon interposition (LRTI) is often performed in cases of carpometacarpal joint osteoarthritis nonresponsive to conservative treatment. The topic of postoperative rehabilitation has been popular recently, with debate regarding whether early mobilization within a few weeks postoperatively can be used safely as opposed to standard immobilization for 6 weeks or more.
What was the principal research question?
Following basal joint arthroplasty, how do clinical outcomes of early motion rehabilitation compare to that of traditional rehabilitation with prolonged immobilization when assessed over the first 12 weeks postoperatively?
Population: 27 patients scheduled for ligament reconstruction and tendon interposition of the carpometacarpal joint. Following surgery, thumbs in all patients were immobilized for 2 weeks using a spica plaster splint.
Intervention: Early mobilization: After 2 weeks of immobilization, patients were switched to a neoprene CMC joint wrap, and were allowed activity as tolerated. (n=13)
Comparison: Immobilization group: After the first 2 weeks of immobilization, patients continued immobilization using a thumb-spica cast or splint for an additional 4 weeks. (n=14)
Outcomes: Outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, a visual analog scale (VAS) for pain, pinch and grip strength, and range of motion.
Methods: RCT
Time: Follow-up scheduled for 6 and 12 weeks postoperatively.
What were the important findings?
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What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.