What is the expected recovery timeline and postoperative care after thumb interphalangeal (IP) joint arthrodesis in a healthy adult, and how do factors such as age, bone quality, diabetes, smoking, or peripheral vascular disease modify it?

Recovery After Thumb IP Joint Fusion

Expected Recovery Timeline

Bone consolidation after thumb interphalangeal joint arthrodesis typically occurs at an average of 9.7 weeks (range 4-17 weeks), with a fusion rate of 98-100% when proper surgical technique is employed. 1, 2

Immediate Postoperative Period (0-2 Weeks)

• Initiate aggressive hand therapy immediately after surgery to prevent permanent stiffness, which is one of the most functionally disabling complications of finger surgery. 3
• Begin active range-of-motion exercises for the MCP and PIP joints while keeping the IP joint protected, performing these multiple times daily. 3, 4
• Apply ice therapy for 10-20 minutes with a thin towel barrier to control pain and swelling during the acute phase. 4
• Use acetaminophen or ibuprofen for analgesia when no contraindications exist; adequate pain control is essential to enable participation in therapy. 3

Early Healing Phase (2-6 Weeks)

• Continue daily active motion exercises emphasizing full composite fist formation to maintain mobility of adjacent joints. 3
• Incorporate gentle passive stretching and joint-mobilization techniques performed by a certified hand therapist to address any developing restrictions. 3
• Progressive strengthening of intrinsic hand muscles should begin to enhance overall hand function. 3

Consolidation Phase (6-12 Weeks)

• Radiographic evidence of bone consolidation is typically observed by an average of 9.7 weeks, though this can range from 4.1 to 17.6 weeks. 1
• All patients in one series achieved 100% fusion at an average of 59.9 days (approximately 8.5 weeks). 2

Functional Recovery (3-6 Months)

• Expect mild residual difficulty with picking up small objects in approximately 78% of patients. 2
• Lateral pinch strength will decrease by approximately 31% compared to a healthy thumb, while tip pinch decreases by approximately 16%. 5
• Overall hand dexterity as measured by standardized tests (Jebsen-Taylor, Grooved Pegboard) is not significantly affected by IP fusion. 5

Optimal Fusion Angle

The preferred fusion angle is 15-30° of flexion for the dominant hand and 15-30° for the nondominant hand, as this range provides the best balance for both power and precision tasks. 6

• Power tasks (opening jars, lifting heavy objects) are best accomplished at 0-30° for the dominant hand. 6
• Precision tasks (writing, buttoning) are preferred at 15° for both hands. 6
• Patient satisfaction ratings are most similar to baseline function at 15° followed by 30° for the dominant thumb. 6

Factors Modifying Recovery

Age

• No significant difference in neurological recovery or fusion rates based on patient age has been demonstrated in the available evidence. 7

Diabetes

• Patients with diabetes require meticulous attention to proper wound care and infection prevention, as they are at particularly high risk for complications. 7
• Cardiovascular morbidity and mortality are markedly elevated in diabetic patients undergoing any surgical procedure. 7
• Proper fitting of any postoperative splinting or orthotic devices is crucial to prevent pressure sores and ulceration at bony prominences. 8
• Blood glucose control must be optimized as part of the comprehensive postoperative care plan. 7

Smoking

• Smoking confers a 1.5-fold increased risk for developing peripheral arterial disease and impaired wound healing. 7
• Smoking cessation should be strongly encouraged preoperatively, as tobacco use significantly impairs bone healing and increases infection risk. 7

Peripheral Vascular Disease

• Patients with peripheral vascular disease have a 2- to 4-fold increase in surgical complications and impaired wound healing. 7
• An ankle-brachial index <0.9 indicates significant peripheral arterial disease that may impair healing. 7
• Toe pressure >55 mmHg and transcutaneous oxygen pressure >50 mmHg are generally required for adequate wound healing. 7
• Revascularization should be considered before elective hand surgery in patients with significant peripheral vascular disease. 7

Bone Quality

• Poor bone quality may necessitate alternative fixation techniques, though the specific evidence for IP joint fusion is limited. 9
• Paramount to successful arthrodesis are appropriate preparation of joint surfaces and careful positioning regardless of bone quality. 9

Common Complications and Management

Pin Tract Infections

• Occur in approximately 22% of cases (4/18 patients in one series) but typically resolve without sequelae with appropriate antibiotic therapy. 2

Hardware Prominence

• Prominent hardware occurs in approximately 17% of cases (3/18 patients), requiring removal in two-thirds of these cases. 2
• Modern superelastic implants demonstrate minimal hardware prominence with only a 1.7% removal rate. 1

Nonunion/Pseudarthrosis

• Extremely rare (1-2%) when proper surgical technique is employed with adequate joint surface preparation and coaptation. 1, 9
• If nonunion occurs, revision surgery is required. 7

Persistent Stiffness

• The most functionally disabling complication, preventable only through immediate and intensive hand therapy. 3
• Any delay in initiating therapy significantly worsens stiffness and may necessitate additional surgery. 3

Critical Postoperative Care Principles

Treatment must be part of a comprehensive care plan that includes frequent wound assessment, appropriate immobilization during the fusion period, aggressive rehabilitation of adjacent joints, and management of all comorbidities. 7

• For patients with inflammatory conditions, a single intra-articular corticosteroid injection in adjacent joints can reduce pain and facilitate more effective rehabilitation if significant swelling develops. 3, 7
• Patients should be instructed to re-evaluate immediately if unremitting pain develops during the immobilization period. 4
• Uninterrupted immobilization of the fusion site is essential, as even brief removal of protection can restart the healing timeline. 4