Is the thumb immobilized after a right thumb interphalangeal (IP) joint arthroplasty?

Postoperative Immobilization After Thumb IP Joint Arthroplasty

Yes, the thumb should be immobilized after interphalangeal (IP) joint arthroplasty, typically for 3-5 days in a plaster cast followed by a thumb spica orthosis until 4 weeks postoperatively.

Immobilization Protocol Following Thumb IP Joint Arthroplasty

Initial Immobilization

• Immediate postoperative immobilization is necessary to protect the surgical site and promote proper healing
• The standard protocol involves:
  • Initial plaster cast immobilization for 3-5 days 1
  • Followed by a thumb spica orthosis that includes the wrist until 4 weeks postoperatively 1

Evidence Supporting Shorter Immobilization

• Research shows that shorter immobilization (3-5 days in plaster) is equally effective as longer immobilization (10-14 days) in terms of:
  • Pain outcomes
  • Hand function
  • Complication rates 1
• Shorter immobilization may reduce patient discomfort and allow for earlier recovery and return to activities 1

Rehabilitation Phases After Thumb Arthroplasty

The rehabilitation process typically follows three phases 2:

1. Acute Phase (0-3 weeks)

• Protective immobilization with plaster cast (3-5 days)
• Transition to removable thumb spica orthosis
• Limited gentle active motion exercises of uninvolved joints
• Edema control measures

2. Unloaded Phase (3-6 weeks)

• Progressive active range of motion exercises
• Removal of orthosis for therapy and light activities
• Continued use of orthosis for protection during other activities

3. Functional Phase (6+ weeks)

• Strengthening exercises
• Progressive return to normal activities
• Discontinuation of orthosis

Surgical Considerations for IP Joint Arthroplasty

• Arthroplasty (typically with silicone implants) is the preferred surgical technique for interphalangeal joint osteoarthritis 3
• For the distal interphalangeal joints, arthrodesis is generally recommended over arthroplasty 3
• Postoperative rehabilitation is essential for optimal outcomes 3

Potential Complications and Management

• Common complications after thumb IP joint arthroplasty include:
  • Pain
  • Joint instability
  • Nerve dysfunction
  • Superficial infection 3
• Proper immobilization helps minimize these complications
• Early active recovery with shorter immobilization does not lead to increased complications compared to longer immobilization protocols 2

Key Considerations for Clinicians

• Patient education about the importance of adhering to immobilization protocols is crucial
• Rehabilitation should be initiated after the initial immobilization period
• Early active motion (after the initial immobilization period) appears to be safe and beneficial for recovery 2
• The specific duration of immobilization may need to be adjusted based on:
  • Stability of the surgical repair
  • Patient's healing capacity
  • Presence of complicating factors

The evidence supports that shorter immobilization periods with early transition to protected motion provide good outcomes while minimizing the negative effects of prolonged immobilization.