Rehabilitation following a MCP joint arthroplasty: exploring variations for silastic and pyrocarbon implants for management of the arthritic joint

Background:

A MCP joint arthroplasty is a common procedure used by hand surgeons for management of finger based rheumatoid arthritis and osteoarthritis.

Problem:

The most effective post operative protocol for a MCP joint Arthroplasty is unclear. Rehabilitation programs will be presented for both the Ascension silastic implant and pyrocarbon implant used for a MCP joint arthroplasty.

Intervention:

Rehabilitation consists of two phases for both implants. Phase one involves wear of a custom made orthosis with the patient performing exercises in a specific range of motion to prevent complications including instability, subluxation, dislocation or fracturing of the implant. Exercises are prescribed in a manner to prevent an extensor tendon lag, and/or joint stiffness. Phase two involves performing unrestricted range of motion exercises and a focus on returning to functional activities. For the silastic implant used for the rheumatoid patient a night time resting hand orthosis is fabricated to prevent recurrence of ulnar drift. Joint protection education is provided for both implants.

Evaluation:

Range of motion measurements and grip strength assessments are completed throughout and at completion of a patient’s rehabilitation program. It is preferable for functional based questionnaires to be completed such as the QuickDASH.

Recommendations:

Therapy following an MCP joint arthroplasty should be specific to the type of implant used. In future these programs can be more effectively evaluated with formalised and standardised pre and post operative assessments.