Postoperative rehabilitation following thumb base surgery: A systematic review of the literature

Abstract

Objective: To provide an overview of rehabilitation for patients who underwent first carpometacarpal joint (CMC-1) arthroplasty, with emphasis on early active mobilization. Data Sources: PubMed/MEDLINE, Embase, CINAHL, and Cochrane were searched. Study Selection: Articles written in English that described the postoperative regimen (including immobilization period/method and/or description of exercises/physical therapy, follow-up 6wk) on CMC-1 arthroplasty were included. Data Extraction: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as guidance in this review, and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale. Data Synthesis: Twenty-seven studies were included consisting of 1015 participants, in whom 1118 surgical procedures were performed. A summary of the components of postoperative rehabilitation used in the included studies of CMC-1 osteoarthritis is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of range of motion and strength exercises) provides positive outcomes for pain, limitations in activities of daily living, and grip and pinch strength, but comparative studies are lacking. Furthermore, 3 postoperative exercises/therapy phases were identified in the literature-the acute phase, the unloaded phase, and the functional phase-but again comparative studies are lacking. Conclusions: Early active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation for CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high-quality comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.