Postoperative best practice for thumb carpometacarpal joint replacement : a Delphi consensus study.

Abstract

Thumb carpometacarpal joint replacement (CMCJR) is gaining popularity for the surgical management of thumb base osteoarthritis. However, there is considerable variability in the literature regarding postoperative management, with limited information on timescales for return to normal function. This study aims to develop consensus-based guidance for postoperative best practice. A three-round modified Delphi process was undertaken with 16 experienced hand surgeons and hand therapists from the UK and mainland Europe. The initial survey was developed following a comprehensive review of the literature and consultation with a patient and public involvement group. The second round was an iteration of the first, including refinement of themes into statements. The third round presented the guidance for overall agreement and comment. Consensus throughout was defined as ≥ 70% agreement. In round one, consensus was reached on postoperative immediate protection duration of ten to 14 days and the need for a postoperative radiograph. In round two, agreement was achieved for seven out of ten statements that included the type of immediate postoperative protection to be a bulky bandage allowing restricted thumb movement, splinting practices, thumb full range of motion commencement, and a return to driving timescale of four weeks. Return to timescales of light (two weeks), moderate (four weeks), and heavy tasks (six to eight weeks) were further defined in round three and accepted by the panellists. This Delphi study established consensus-based guidance for best practice in the postoperative management of thumb CMCJR, with specific inclusion of timescales for return to normal function. This will be beneficial for clinics, particularly in the UK, which are newly adopting this technique. Recommendations regarding the timing and frequency of postoperative radiographs remain to be clearly defined.