JHT READ FOR CREDIT ARTICLE #324. Scientific/Clinical Article Rigid versus semi-rigid orthotic use following TMC arthroplasty: A randomized controlled trial Rosemary Prosser PhD, MSc (Hand & Upper Limb) a, * , Mark J. Hancock PhD, BAppSc (Phty) b , Leslie Nicholson PhD, MAppSc (Phty) b , Cathy Merry MHlthSc, BAppSc (Phty) a , Felicity Thorley MPH, BOcThy a , Douglass Wheen MBBS, FRACS c a Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia b Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia c Hand Surgery Centre, St Lukes Hospital Hand Unit, Potts Point, Sydney, Australia article info Article history: Received 28 March 2014 Received in revised form 10 June 2014 Accepted 12 June 2014 Available online 21 June 2014 Keywords: Thumb Arthroplasty Orthosis Osteoarthritis abstract Introduction: The trapeziometacarpal (TMC) joint of the human thumb is the second most common joint in the hand affected by osteoarthritis. TMC arthroplasty is a common procedure used to alleviate symptoms. No randomized controlled trials have been published on the efficacy of different post- operative orthotic regimes. Method: Fifty six participants who underwent TMC arthroplasty were allocated to either rigid orthotic or semi-rigid orthotic groups. Both groups started an identical exercise program at two weeks following surgery. Outcome measures were assessed by an assessor blinded to group allocation. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) and secondary outcomes included the Michigan Hand Questionnaire (MHQ), thumb palmar abduction, first metacarpophalangeal extension and three point pinch grip. Measures were taken pre-operatively, at six weeks, three months and one year post-operatively. Between-group differences were analyzed with linear regression. Results: Both groups performed equally well. There was no significant between-group difference for PRWHE scores (0.47, CI 11.5 to 12.4), including subscales for pain and function, or for any of the sec- ondary outcomes at one year follow-up. Conclusion: We found no difference in outcomes between using a rigid or semi-rigid orthosis after TMC arthroplasty. Patient comfort, cost and availability may determine choice between orthoses in clinical practice. Level of evidence: 1b RCT. Ó 2014 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. Introduction The trapeziometacarpal (TMC) joint of the thumb is the second most common joint in the hand affected by osteoarthritis. 1 This condition is both painful and produces significant disability. 2e5 It may affect hand activities in all aspects of life. 3,6e8 While some pa- tients improve with conservative management, a substantial pro- portion proceed to surgical treatment in the form of arthroplasty. 8 Post-operative rehabilitation is an important component of surgical management and is likely to significantly impact on the success, or otherwise, of the procedure. 9 The usual post-operative management after arthroplasty is a period of complete or relative immobilization. This immobilization period is designed to protect the surgery and allow the joint to heal in a stable position. Some authors advocate cast immobilization for four weeks 10,11 then wearing an orthosis (splint) for another four weeks. 12,13 Others report complete immobilization using a forearm-based rigid orthosis for four to six weeks. 14e17 Anecdotal experience suggests that while some patients suffer post immobilization stiffness of the wrist and thumb following casting or orthotic wear, others benefit from immobilization in terms of increased comfort with minimal stiffness. Complications such as radial neuritis and complex regional pain syndrome (CRPS) 18,19 have also been attributed, at least in part, to casting or rigid orthotic use. Only one published randomized controlled trial has reported on the impact of post-operative care following TMC arthroplasty. Evaluating different periods of post-operative mobilization in 39 patients at 6 months follow-up, Horlock and Belcher 14 reported no significant difference between commencing thumb exercises and light activity with intermittent rigid orthotic use at one week compared to commencing the exercises at four weeks. Horlock and * Corresponding author. E-mail address: rosemary_hands@msn.com.au (R. Prosser). Contents lists available at ScienceDirect Journal of Hand Therapy journal homepage: www.jhandtherapy.org 0894-1130/$ e see front matter Ó 2014 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jht.2014.06.002 Journal of Hand Therapy 27 (2014) 265e271