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A Chance “Mutation” – The Evolution of a Hand Therapy Regimen for Tupper Arthroplasty
R. W. Trickett, MBBCh, MSc, FRCS1; J. Bullock2; J. A. Oni, MA, MBBCh, FRCS1
1Department of Hand Surgery, Queen's Medical Centre, Nottingham, United Kingdom; 2Physiotherapy Department, Queen's Medical Centre, Nottingham, United Kingdom

Introduction: The Tupper palmer plate interposition arthroplasty has been utilised as an alternative to implant arthroplasty for the management of metacarpophalangeal joint (MCPJ) osteoarthritis (OA). Post-operative rehabilitation guidelines following pyrocarbon arthroplasty are available, yet an optimal protocol following the Tupper arthroplasty is lacking. This preliminary report describes the evolution of rehabilitation following a “chance mutation” in protocol, as part of a continuous prospective audit of results.

Materials & Methods: Patients undergoing Tupper arthroplasty were historically managed in a standardized manner (Phase 1) this comprised of 2 weeks immobilization followed by restrictive splinting and cautious mobilization of the MCP joints. In attempt to improve the overall range achieved, Phase 2 patients were immobilized for 1 week followed by less restrictive splinting and MCPJ restrictions. An incidental “mutation” of therapy occurred when 2 consecutive patients were non-compliant with advice, mobilizing freely with minimal splint utilization (Phase 3). Ranges of movement and Numerical Rating Scores for pain were recorded. Patient feedback was also captured as part of routine physiotherapy care.

Results: Sixteen joints were evaluated, with mean follow-up of 62 months (1.6 to 53.9 months). Adjacent to the therapy reforms, a change in surgical technique was also instigated during Phase 1. Outcome measures are described in Table 1.

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