Intervention Review

Post-operative therapy for metacarpophalangeal arthroplasty

  1. Nicola Massy-Westropp1,*,
  2. Renea V Johnston2,
  3. Catherine L Hill3

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 15 OCT 2007

DOI: 10.1002/14651858.CD003522.pub2


How to Cite

Massy-Westropp N, Johnston RV, Hill CL. Post-operative therapy for metacarpophalangeal arthroplasty. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003522. DOI: 10.1002/14651858.CD003522.pub2.

Author Information

  1. 1

    University of South Australia, Health Sciences, Adelaide, South Australia, Australia

  2. 2

    Department of Epidemiology and Preventive Medicine, Monash University, Monash Department of Clinical Epidemiology at Cabrini Hospital, Malvern, Victoria, Australia

  3. 3

    The Queen Elizabeth Hospital, Rheumatology Unit, Woodville, South Australia, Australia

*Nicola Massy-Westropp, Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, 5000, Australia. nicola.massy-westropp@unisa.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Metacarpophalangeal (MCP) arthroplasty with implants, which is the replacement of painful knuckle joints with artificial knuckle joints, has been performed for people with rheumatoid arthritis (RA) since the 1960s. The surgery is done because RA can cause damage of the knuckle joints making them unable to straighten out (flexion deformity) and causing them to lean over toward the small finger (flexion or ulnar deviation deformity). For eight to 12 weeks following surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. Post-operative therapy regimes share common aims of encouraging MCP flexion and extension without the recurrence of flexion or ulnar deviation deformity.

Objectives

To compare the effectiveness of post-operative therapy regimes for increasing hand function after MCP arthroplasty in adults with rheumatoid arthritis.

Search methods

The Cochrane Musculoskeletal Group Register, MEDLINE (January 1950 to August 2006), EMBASE (January 1993 to August 2006), CINAHL (January 1982 to August 2006), Digital Dissertations (January 1960 to August 2006), DARE (The Cochrane Library 2006, Issue 3), Current Contents Connect (January 1998 to August 2006), and AMED (January 1985 to August 2006) were searched for randomised controlled trials and controlled clinical trials using rheumatoid arthritis and hand as the search terms. The bibliographies of all trials identified by this strategy were also searched and primary authors were contacted for unpublished data and also clarification regarding study protocols.

We performed handsearches of all relevant society conference proceedings and reference lists of retrieved articles. No language limits were applied, although searches were only relevant after the 1950s when MCP arthroplasty began to be performed.

Selection criteria

Randomised controlled trials and controlled clinical trials were accepted if they evaluated the efficacy of a post-operative therapy regime for MCP arthroplasty.

Data collection and analysis

No data analyses were performed as only one controlled clinical trial was found. The data from that study are described.

Main results

Our search only identified one controlled clinical trial involving 22 participants. The majority of the evidence for various splinting and exercise regimes consisted of case series and case studies. Results from the one (poor quality) trial suggest that the use of continuous passive motion is not effective in increasing motion or strength after MCP arthroplasty.

Authors' conclusions

Well-designed randomised controlled trials which compare the efficacy of different therapeutic splinting programmes following MCP arthroplasty are required. At this time, the results of one study (silver level evidence) suggest that continuous passive motion alone is not recommended for increasing motion or strength after MCP arthroplasty.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Post-operative therapy for metacarpophalangeal arthroplasty (knuckle joint replacement) in rheumatoid arthritis (RA)

This summay of a Cochrane review presents what we know from research about the effect of post-operative therapy for metacarpophalangeal (MCP) arthroplasty. The review shows that in people with RA:

- there was not enough information in the included study to tell whether wearing a hand splint and performing exercises (continuous passive motion) after surgery improves hand function, relieves pain, or corrects deformity.

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible complications of knuckle joint replacement may include infection, changes to the bones around the implant, or the chance that the implant could break and cause problems to the hand. It is not known if there are any additional side effects of post-operative therapy.

What is RA and what is post-operative therapy for metacarpophalangeal (MCP) arthroplasty?

In rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. the small joints of your hands are usually affected first.

Metacarpophalangeal (MCP) arthroplasty with implants is the replacement of painful knuckle joints with artificial knuckle joints.The surgery is done because RA can also cause damage to the knuckle joints, making them unable to straighten out and causing them to lean over toward the small finger.

For eight to 12 weeks after the surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. This is known as post-operative therapy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

掌指關節置換之術後治療

掌指關節置換手術是將疼痛的指關節以人工指關節來取代,自1960年代起即被使用於類風濕性關節炎的病患。執行手術的理由是因為類風濕性關節炎會侵犯指關節,導致手指無法伸展(攣縮變形)及往小指側傾斜(屈側或尺側偏移)。手術後的八至十二週,病患配帶手部護木進行運動,以利手部活動之復原。手術後治療的目標在於促進掌指之伸屈,並避免屈側或尺側偏移變形之復發。

目標

在於比較成年人接受掌指關節置換之術後治療效益。

搜尋策略

搜詢下列各大資料庫中 [包括The CochraneMusculoskeletal Group Register, MEDLINE (January 1950 to August 2006), EMBASE (January 1993 to August 2006), CINAHL (January 1982 to August 2006), Digital Dissertations (January 1960 to August 2006), DARE (The Cochrane Library 2006, Issue 3), Current Contents Connect (January 1998 to August 2006), and AMED (January 1985 to August 2006)] 以類風濕性關節炎為主題之隨機臨床試驗及對照臨床試驗,以及相關文章發表,並與原作者聯繫及取得未發表之資料以及研究計劃之確認。同時著手搜詢相關學會之會議發表及其引用文獻。以1950年掌指關節置換手術開始施行之後為搜詢的範圍,但無語言之限制。

選擇標準

只要是探討掌指關節置換術後治療的隨機臨床試驗及對照臨床試驗,都被列入。

資料收集與分析

未作數據資料分析,因為僅找到一篇對照臨床試驗。其資料?述如下。

主要結論

此一對照臨床試驗(劣質)在於探討22個位病例術後不同的護木固定方式及復健運動,結果顯示在掌指關節置換術後,持續性被動式運動並無增加活動角度或強度之效用。

作者結論

設計良好的隨機對照試驗作為比較掌指關節置換術後不同護木治療方案之效用是有其必要性。現有的一篇研究(銀級證據)顯示在掌指關節置後,單純使用持續性被動式運動不具有增加活動角度或強度之效益。

翻譯人

本摘要由林口長庚醫院陳昭宇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

類風濕性關節炎接受掌指關節置換之術後治療 此篇考科藍實證醫學論文回顧摘錄了現有探討掌指關節置換術後治療之研究,對於類風濕性關節炎患者,尚無充份資料證實術後佩戴護木、或運動(持續性被動式運動)可以改善手部功能、緩解疼痛或矯正變形。對於副作用及併發症,我們常缺乏正確的資訊,特別是少見但嚴重的副作用。指節關節置節之可能併發症包括了感染、關節植入物附近之骨骼變化或可能因植入物斷裂而引發之手部問題。對於術後治療可能併發之副作用則不甚了解。 什麼是類風濕性關節炎以及掌指關節置換之術後治療? 在類風濕性關節患者,體內抵抗感染之免疫系統會攻擊關節內組織,導致關節腫漲、僵硬及疼痛。手部之小關節經常是最先發病。掌指關節置換手術是以人工關節植入來取代疼痛的指節。手術的理由是因為,類風濕性關節炎侵犯指關節,導致無法伸展並向小指側傾斜變形。在術後的八至十二週,病患佩戴手部護木及進行手部運動以維持並增進活動功能;這便是眾所週知的術後治療。