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Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched Study

  • Author Footnotes
    ∗ Tsehaie and Wouters contributed equally to this article.
    Jonathan Tsehaie
    Correspondence
    Corresponding author Jonathan Tsehaie, BSc, Erasmus MC Rotterdam, Dr Molewaterplein 50, Room EE 15.91b, 3015 GE Rotterdam, The Netherlands .
    Footnotes
    ∗ Tsehaie and Wouters contributed equally to this article.
    Affiliations
    Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

    Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands

    Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    ∗ Tsehaie and Wouters contributed equally to this article.
    Robbert M. Wouters
    Footnotes
    ∗ Tsehaie and Wouters contributed equally to this article.
    Affiliations
    Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

    Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands

    Center for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands
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  • Reinier Feitz
    Affiliations
    Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands
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  • Harm P. Slijper
    Affiliations
    Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands
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  • Steven E.R. Hovius
    Affiliations
    Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

    Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands
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  • Ruud W. Selles
    Affiliations
    Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

    Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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  • theHand-Wrist Study Group
  • Author Footnotes
    ∗ Tsehaie and Wouters contributed equally to this article.
Published:April 23, 2019DOI:https://doi.org/10.1016/j.apmr.2019.02.016

      Abstract

      Objective

      To investigate if shorter immobilization is noninferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis

      Design

      Prospective cohort study with propensity score matching.

      Setting

      Data collection took place in 16 outpatient clinics for hand surgery and hand therapy.

      Participants

      A total of 131 participants with shorter immobilization and 131 participants with longer immobilization (N=262).

      Intervention

      Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for first carpometacarpal joint osteoarthritis. Propensity score matching was used to control for confounders.

      Main Outcome Measures

      Outcomes were pain measured with a visual analog scale and hand function measured with the Michigan Hand Outcomes Questionnaire at 3 and 12 months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment, and return to work.

      Results

      No significant differences were found in visual analog scale pain (effect size, 0.03; 95% confidence interval [CI], −0.21 to 0.27) or the Michigan Hand Outcomes Questionnaire (effect size, 0.01; 95% CI, −0.23 to 0.25) between the groups at 3 months or at 12 months. Furthermore, no differences were found in complication rate or in other secondary outcomes.

      Conclusions

      In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal to longer immobilization for outcomes on pain, hand function, and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner, which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following first carpometacarpal joint arthroplasty.

      Keywords

      List of abbreviations:

      CMC-1 (first carpometacarpal joint), FCR (flexor carpi radialis), MCP-1 (first metacarpophalangeal joint), MHQ (Michigan Hand Outcomes Questionnaire), OA (osteoarthritis), ROM (range of motion), VAS (visual analog scale)
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