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Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched
Jonathan Tsehaie1, Robbert M Wouters2, Reinier Feitz3
1Department 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.
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.
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