This summay of a Cochrane review presents what we know from research about the effect of post-operative therapy for metacarpophalangeal (MCP) arthroplasty. The review shows that in people with RA:
- there was not enough information in the included study to tell whether wearing a hand splint and performing exercises (continuous passive motion) after surgery improves hand function, relieves pain, or corrects deformity.
We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible complications of knuckle joint replacement may include infection, changes to the bones around the implant, or the chance that the implant could break and cause problems to the hand. It is not known if there are any additional side effects of post-operative therapy.
What is RA and what is post-operative therapy for metacarpophalangeal (MCP) arthroplasty?
In rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. the small joints of your hands are usually affected first.
Metacarpophalangeal (MCP) arthroplasty with implants is the replacement of painful knuckle joints with artificial knuckle joints.The surgery is done because RA can also cause damage to the knuckle joints, making them unable to straighten out and causing them to lean over toward the small finger.
For eight to 12 weeks after the surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. This is known as post-operative therapy.
Read the full abstract
Metacarpophalangeal (MCP) arthroplasty with implants, which is the replacement of painful knuckle joints with artificial knuckle joints, has been performed for people with rheumatoid arthritis (RA) since the 1960s. The surgery is done because RA can cause damage of the knuckle joints making them unable to straighten out (flexion deformity) and causing them to lean over toward the small finger (flexion or ulnar deviation deformity). For eight to 12 weeks following surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. Post-operative therapy regimes share common aims of encouraging MCP flexion and extension without the recurrence of flexion or ulnar deviation deformity.
Objectives
To compare the effectiveness of post-operative therapy regimes for increasing hand function after MCP arthroplasty in adults with rheumatoid arthritis.
Search strategy
The Cochrane Musculoskeletal Group Register, MEDLINE (January 1950 to August 2006), EMBASE (January 1993 to August 2006), CINAHL (January 1982 to August 2006), Digital Dissertations (January 1960 to August 2006), DARE (The Cochrane Library 2006, Issue 3), Current Contents Connect (January 1998 to August 2006), and AMED (January 1985 to August 2006) were searched for randomised controlled trials and controlled clinical trials using rheumatoid arthritis and hand as the search terms. The bibliographies of all trials identified by this strategy were also searched and primary authors were contacted for unpublished data and also clarification regarding study protocols.
We performed handsearches of all relevant society conference proceedings and reference lists of retrieved articles. No language limits were applied, although searches were only relevant after the 1950s when MCP arthroplasty began to be performed.
Selection criteria
Randomised controlled trials and controlled clinical trials were accepted if they evaluated the efficacy of a post-operative therapy regime for MCP arthroplasty.
Data collection and analysis
No data analyses were performed as only one controlled clinical trial was found. The data from that study are described.
Main results
Our search only identified one controlled clinical trial involving 22 participants. The majority of the evidence for various splinting and exercise regimes consisted of case series and case studies. Results from the one (poor quality) trial suggest that the use of continuous passive motion is not effective in increasing motion or strength after MCP arthroplasty.
Authors' conclusions
Well-designed randomised controlled trials which compare the efficacy of different therapeutic splinting programmes following MCP arthroplasty are required. At this time, the results of one study (silver level evidence) suggest that continuous passive motion alone is not recommended for increasing motion or strength after MCP arthroplasty.
