26 Postoperative Therapy for Metacarpophalangeal Arthroplasty Nicola Massy-Westropp School of Health Sciences, University of South Australia Australia 1. Introduction Since the earliest metacarpophalangeal (MCP) arthroplasties in the 1950s, numerous resurfacing and excisional arthroplasties, and a greater choice of surgical tools and techniques to implant the prostheses have become available. Of the excisional arthroplasties, one-piece and two-piece hinge designs, constrained by screws or unconstrained, cemented and non-cemented, have been designed (1) Surgeons now perform these procedures as day surgery, and leave as much original bone as possible in the likelihood of replacing the prosthesis as the patient ages. At the time of surgery, synovectomy and soft-tissue balancing procedures are often performed to increase lateral joint stability or enhance the biomechanical advantage of the tendons around the operated joint. These procedures may necessitate post-operative immobilisation, specific joint positioning and strict motion protocols to achieve the best soft tissue range of motion and stability around the prosthesis (2-6). The efficacy of postoperative therapy regimens also requires research, as they affect patient outcome, and are time-consuming and expensive. The aim of this review is to determine which postoperative regimen are most effective in achieving freedom from pain and function, and if any particular regimen is best suited to a specific prosthesis or soft-tissue balancing procedure at the time of surgery. 2. Method For inclusion in this review, studies had to evaluate the efficacy of a post-arthroplasty regimen for patients who had metacarpophalangeal or joint arthroplasty. Preferred study designs were metanalyses, systematic reviews, and randomised controlled trials, but all published literature except expert opinion was accepted. Patients may have received any type of implant and soft-tissue procedure, due to rheumatoid arthritis, osteoarthritis or trauma. Electronic databases searched were the Cochrane Musculoskeletal Disease Group Register, The Cochrane Library of Systematic review, Google Scholar, and Scopus. Manual searches included of the Journal of Hand Therapy, Hand Therapy and the Journal of Arthroplasty. Search terms in all combinations included ‘joint replacement, hand, wrist metacarpophalangeal, arthroplasty, rehabilitation, post-operative, occupational therapy, physical therapy’. The search included papers from 1990 onward, aiming to find research about currently used prostheses and not prostheses of older designs and materials. www.intechopen.com