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掌指关节置换术

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由手部治疗师主导的硅胶（Swanson）指关节置换术后康复计划，以动态伸直夹板为核心，在早期屈曲时保持指关节伸直并略微偏向桡侧——通过矫正位置重塑关节，并纠正尺偏畸形。

指关节（掌指关节）示意图，手指向小指侧偏移，通过关节置换术进行矫正。
磨损、变形的掌指关节（MCP）被替换为柔性间隔物，以恢复更自然的线条和有用的活动。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

本方案由基兰·希尔帕拉（Kieran Hirpara）医生在罗克汉普顿 Mater 私人医院为您提供，指导您进行硅胶（Swanson）人工关节置换术后指关节（掌指关节，即“MCP”关节）的康复过程。方案首先介绍您的家庭锻炼计划，随后是专为您的手部治疗师制定的结构化临床方案：请将此页面或其 PDF 文件带给您的首次治疗访视，以确保您的康复过程协调一致。您的手部治疗师可能会根据您的康复进展调整计划。

本康复过程以手部治疗为核心，并依赖夹板固定。动态夹板及您的日常锻炼并非可选项目：正是通过夹板固定和运动，才能使新关节塑形并矫正为伸直位。您的最终效果在很大程度上取决于您是否忠实执行夹板固定和运动。

如果您对术后伤口有任何疑虑，请与诊所联系。拍摄伤口照片并发送电子邮件供医生审阅通常会有所帮助。

预期情况

掌指关节可能发生磨损、疼痛和严重畸形，最常见于类风湿关节炎，此时手指向小指侧偏移（尺偏），且手指基底向手掌方向滑脱（掌侧半脱位）；也可能因骨关节炎而发生磨损。本手术将切除磨损的掌指关节，并植入柔性硅胶间隔物（经典的斯旺森假体）。手术目的是缓解疼痛、纠正偏移和垂指（伸肌滞后），并恢复有用的屈曲活动范围。

该假体并非刚性铰链。它作为柔性间隔物发挥作用，在最初几周内，周围会形成新的衬里（即“关节囊”）。康复的核心目标是使关节囊在手指保持伸直和矫正位置（而非偏移状态）下形成。这就是为什么夹板和早期活动至关重要的原因。

因此，康复过程围绕动态伸展外展夹板展开，通常在最初几天内佩戴：

  • 休息时，夹板使掌指关节保持伸直，并轻轻向拇指侧牵拉（桡偏），直接对抗原有的尺偏。
  • 在夹板保护下，您可对掌指关节进行早期的受控主动屈曲练习，对抗柔软的弹性环，使手指重新伸直。早期活动（但仅限于这种受保护的矫正位置）有助于正确塑造新的关节囊，并防止关节僵硬。

您需要几乎持续佩戴动态夹板约六周，随后过渡到休息/夜间夹板，并在后期逐步增加力量训练。手部轻度功能在最初几周内恢复；大多数人在约三个月时能恢复大部分日常活动，最终效果在随后的几个月内继续稳定。

注意事项与限制

  • 按医嘱佩戴动态伸展夹板： 最初约六周内，白天和夜间均需佩戴。夹板用于维持矫正效果；过早或过多取下会导致手指再次发生偏斜。
  • 切勿让手指向小指侧（尺侧）偏斜。每项练习均引导手指向相反方向，即朝向拇指侧。
  • 早期切勿进行强力握持、捏取或提举重物：强力握持会使手指陷入尺侧偏斜，并在关节尚未稳定前对其造成应力。强化训练需待手部治疗师许可后方可进行。
  • 从开始即保持拇指、手腕及指尖的活动，并在舒适范围内将手用于日常轻度活动。
  • 密切观察伤口是否有感染迹象（红肿加剧、发热、肿胀或分泌物），如有疑虑请联系诊室；植入物周围感染虽不常见，但早期发现至关重要。

关于伤口、肿胀及瘢痕管理，请参阅诊所的伤口护理指南。

您的锻炼

这些是您讲义中的锻炼项目。仅在 Hirpara 医生和您的手部治疗师的指导下开始进行，并严格遵循您被允许的关节活动范围和限制。早期锻炼均在佩戴动态夹板的情况下进行：对抗弹力环进行受控屈曲、主动伸直，以及轻柔地将手指向拇指方向移动以维持矫正效果。伤口愈合后开始进行疤痕护理。握力强化属于后期阶段，在您获得明确许可前不得开始。如果掌指关节出现锐痛，请立即停止任何相关动作。

您的临床方案

本页面其余部分为硅胶（Swanson）掌指关节成形术后的分阶段康复临床方案。本节内容需提供给您的手部治疗师，每个阶段均以通俗易懂的语言解释当前阶段的治疗目标。核心原则是：新的掌指关节囊会在您保持的体位周围重塑，因此夹板和锻炼需将关节固定在伸直伴轻度桡偏位，同时允许早期受控的主动屈曲，从而将关节重塑至矫正位置并纠正尺偏畸形。

治疗前，请查阅患者的手术记录和既往病史，并与主刀医生沟通，明确诊断（类风湿关节炎 vs 骨关节炎）、所进行的软组织重建术式（桡侧副韧带紧缩术、尺侧内在肌松解术、伸肌中央束居中术/交叉内在肌转移术），以及术中达到的矫正度和活动弧。类风湿性手的尺偏畸形更易复发，因此需特别严格地进行桡偏位夹板固定。以下方案基于标准的动态伸直支具外展架方案。

第一阶段——动态伸展夹板联合早期可控活动（第0至约6周）

前六周是关键窗口期：关节囊此时围绕植入物形成，动态夹板决定了其形成的位置。通常在术后3-5天内佩戴基于前臂的动态掌指关节（MCP）伸展支架式夹板。休息时，夹板使掌指关节保持完全伸展，近节指骨被拉向轻度桡偏（以矫正既往的尺侧偏移）；支架悬带位于近节指骨上，弹性张力允许可控的主动屈曲，随后将手指回拉至伸展位。患者需在清醒的每一小时进行夹板内的早期可控掌指关节主动屈曲。腕关节和指间关节保持自由活动。

致您的手部治疗师：

教育与注意事项 - 适配并调节动态伸展支架式夹板：掌指关节保持伸展+轻度桡偏，悬带置于近节指骨，施加桡侧拉力以对抗尺侧偏移 - 持续佩戴（昼夜）约6周，仅在卫生护理和 supervised 锻炼时取下 - 禁止强力握持、捏持或侧向（尺侧方向）负荷： 这些动作会重现致畸应力 - 保护任何软组织重建（桡侧副韧带/内在肌平衡）：始终避免强制性的尺侧偏斜应力 - 保持拇指、腕关节和指间关节的活动度；仅进行轻度的无负荷手部活动

管理措施 - 伤口：按医嘱处理手术敷料；监测感染迹象（存在植入物） - 水肿：抬高患肢、轻柔的逆行按摩、根据耐受情况使用轻度加压 - 锻炼：在夹板内对抗悬带进行可控的掌指关节主动屈曲，旨在发展有用的屈曲弧（目标为术中的屈曲弧，通常食指至小指的掌指关节可达约70度），并通过支架实现完全的被动伸展回位；掌指关节主动伸展（矫正伸肌滞后）；桡偏再教育（引导手指朝向拇指方向）；指间关节和腕关节自由活动

进展标准 - 伤口愈合；水肿消退；出现主动屈曲弧，并在约6周时保持伸展位及矫正后的（桡侧）排列

第二阶段——逐步停用夹板并巩固矫正效果（约第6至12周）

约6周时，关节囊逐渐成熟，动态夹板逐步过渡为休息/夜间伸直夹板（通常持续至约12周，类风湿性关节炎患者因易复发，夜间佩戴时间可能更长）。脱离夹板后的主动活动逐步增加，始终侧重于伸直和桡偏。轻度功能性使用逐步扩大；但仍避免强力握持和捏持。

致您的手治疗师：

评估 - 主动和被动掌指关节（MCP）屈伸活动范围；伸肌滞后；尺偏（与术中矫正效果对比）；疼痛和肿胀情况；伤口/瘢痕复查

教育和注意事项 - 逐步停用动态夹板；继续佩戴夜间/休息伸直夹板至约12周（类风湿性关节炎患者夜间佩戴时间可能更长） - 继续避免强力握持/捏持以及任何导致尺偏的负荷 - 严密维持桡偏矫正效果；漂移复发是主要的晚期失败原因

管理措施 - 锻炼：在夹板外逐步进行主动和轻柔的主动辅助掌指关节屈伸；持续进行伸肌滞后训练和桡偏再教育；愈合后开始瘢痕管理；在舒适范围内进行轻度功能性任务，避免尺偏模式

进阶标准 - 矫正效果稳定（关节囊成熟过程中复发性尺偏最小化，可接受的伸肌滞后）；功能性活动范围舒适；疼痛逐渐缓解

第三阶段——强化与功能恢复（约12周及以后）

一旦关节囊变得坚固且对位维持良好（约12周时），将谨慎地、晚期引入分级强化训练，因为握力会诱发尺偏。力量和最终的功能结果将在随后的几个月内继续改善。

供您的手部治疗师参考：

评估 - 与健侧及术前相比的握力/捏力；负荷下的活动度维持、伸展及对位；功能性和任务特异性测试

教育与注意事项 - 仅在约8-12周时开始分级握力/强化训练，并逐渐增加负荷 - 指导不会导致尺偏的握力模式；根据指征持续夜间夹板固定，特别是在类风湿关节炎患者中 - 设定合理的期望值：目标是缓解疼痛、矫正位置和功能性的活动弧，而非获得正常或有力的手

管理 - 练习：渐进式橡皮泥/球类握力和捏力训练、掌指关节（MCP）等长控制、功能性强化；继续活动度训练以及任何残留的伸肌滞后/对位矫正工作 - 若对位稳定、获得有用的活动弧且患者能够管理日常生活功能，可考虑出院；提供长期夜间夹板固定和关节保护计划 - 如果对位恶化、活动弧丧失或怀疑植入物出现问题，请转诊回主治医生

出院标准 - 对位稳定、功能性无痛活动弧、足够的功能性握力、良好的关节保护和夜间夹板固定常规

恢复工作与活动

在舒适的前提下，鼓励从一开始就进行轻度的日常手部活动（如进食、书写、轻度自理），前提是避免用力握持、捏取以及手指承受任何侧向（尺侧）应力。计划在前六周内几乎全天佩戴动态夹板，这将限制双手操作及重体力任务；请据此安排协助。驾驶需在能够安全操控车辆，并且驾驶时已摘下动态夹板后恢复（通常在六周左右），并经复查确认。

强化训练及更重的手部活动需等待至约十二周，随后在您的手部治疗师指导下逐步增加。大多数人约在三个月时恢复大部分日常活动，最终效果（舒适度、对位及有效活动弧）将在随后的几个月内继续稳定。进展由Hirpara医生及您的手部治疗师根据手部矫正和功能情况评估，而非仅依据日历时间。较重的或重复性手工劳动遵循相同的基于标准的进展原则，并提供关节保护建议以维持长期矫正效果。

术后方案

本方案与诊所的一般康复建议配合使用：请参阅术后疼痛管理、伤口护理和疤痕管理。上述分阶段计划反映了硅胶掌指关节（MCP）置换术后长期采用的斯旺森（Swanson）式康复方案，您的后续康复由希帕拉（Hirpara）医生和您的手部治疗师根据您手部的矫正情况和进展进行个体化指导。

Reviewed by Dr Kieran Hirpara · 21 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Silicone (Swanson) MCP Joint Arthroplasty — Procedure Outcomes & Post-operative Rehabilitation

Topic scope: post-operative rehabilitation after silicone (Swanson) replacement of the metacarpophalangeal (MCP) joints — flexible silicone-elastomer spacer arthroplasty of the knuckle joints, most often for the rheumatoid hand with ulnar drift and volar subluxation, and less commonly for MCP osteoarthritis. This is a resection-replacement with soft-tissue rebalancing, not a simple decompression: the deforming forces that destroyed the joint (ulnar drift, extensor subluxation, intrinsic tightness) are still present, so the rehabilitation is an active, splint-driven re-shaping programme, not a rest-and-protect pathway.

Defining principle of the rehab here: a silicone MCP implant is a flexible spacer around which a new fibrous capsule ("encapsulation") forms over the first weeks — and that capsule remodels in whatever position the hand is held. The classic post-operative regime therefore uses a dynamic extension outrigger splint that holds the MCPs in extension with slight radial deviation (opposing the ulnar drift) while permitting early controlled active flexion against elastic loops. Move early, but only in the corrected position: this is what reverses the drift and builds a functional flexion arc. The single biggest branch point is the diagnosis — the rheumatoid hand drifts and recurs far more readily than the osteoarthritic hand and warrants more diligent, more prolonged radial-deviation splinting.

A. PROCEDURE OUTCOMES (rheumatoid and osteoarthritis)

Silicone MCP arthroplasty is a deformity-correcting, pain-relieving operation rather than a motion- or strength-restoring one. Its great strength is reliable correction of alignment and relief of pain; its accepted limitations are a modest final arc, gradual implant fracture over years, and—in rheumatoid hands—a tendency to recurrent drift.

  • In rheumatoid arthritis it produces durable improvement in deformity, appearance and patient-reported function. The multicentre prospective SARA (Silicone Arthroplasty in Rheumatoid Arthritis) cohort compared 70 surgical with 93 non-surgical RA patients with severe MCP deformity: the surgical group showed significant, sustained gains in the Michigan Hand Outcomes Questionnaire and in ulnar deviation, extensor lag and arc of motion, maintained at 1 year, at long-term (3-year) follow-up, and out to 7 years, whereas the non-surgical cohort did not improve [Chung 2009; Chung 2012; Chung 2017]. Moderate–strong (prospective comparative cohort; not randomised).
  • Correction of ulnar drift and extensor lag is the headline result; arc and grip gains are modest. Series consistently report large reductions in ulnar deviation and extensor lag with a re-centred, more functional arc (commonly a final arc on the order of ~40–50° centred nearer extension), with grip strength only modestly changed. The operation buys alignment, pain relief and hand appearance/function, not power [Goldfarb & Dovan 2006; Rizzo 2011; Kirschenbaum 1993]. Moderate.
  • For MCP osteoarthritis, long-term results are favourable and durable. A long-term series of silicone MCP arthroplasty for OA reported lasting pain relief and satisfactory function, with better-preserved bone stock and less recurrent deforming force than the rheumatoid hand [Morrell & Weiss 2018]. Moderate.
  • Implant fracture accrues with time but is often clinically silent. Long-term radiographic follow-up shows implant fracture rates rising over the years, yet many fractured implants remain asymptomatic and revision is driven by symptoms/instability rather than radiographic fracture alone [Koenuma 2024; Kirschenbaum 1993]. Moderate.
  • Revision is uncommon but defined, most often for recurrent deformity, implant fracture/instability or infection; revision MCP arthroplasty is feasible but technically demanding with poorer results than primary surgery [Wagner 2019; Carlson Strother 2023]. Moderate.

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) which splint regime, and (2) does adding continuous passive motion or particular splint variants change the outcome. The evidence base is dominated by a strong heritage regime (Swanson-style dynamic extension splinting) supported mostly by expert consensus and low-level studies, with the few controlled comparisons failing to show benefit from add-ons. The rehabilitation is nonetheless indispensable — it is integral to the operation, not an optional adjunct.

  • The standard regime is a dynamic extension outrigger splint with early controlled motion. Fitted within the first few days, it holds the MCPs in extension and slight radial deviation at rest and permits active flexion against finger slings, worn essentially continuously for ~6 weeks then weaned to night/rest splinting. The shared aim across published regimes is to encourage MCP flexion and extension without recurrence of flexion contracture or ulnar deviation while the capsule encapsulates the implant in a corrected position [Goldfarb & Dovan 2006; Massy-Westropp Cochrane 2008]. Consensus / heritage — widely practised, low-level evidence.
  • Adding continuous passive motion (CPM) to dynamic splinting does not help. The Cochrane review identified a single small controlled trial (22 participants) comparing dynamic splinting ± CPM and concluded CPM is not effective at increasing motion or strength after MCP arthroplasty (controls actually gained more motion); it rated the evidence "silver level" and called for well-designed RCTs given wide practice variation [Massy-Westropp Cochrane 2008]. Moderate (Cochrane SR of low-certainty primary evidence).
  • A static-splint alternative achieves comparable correction in small studies. A prospective series using alternating static flexion/extension splints (rather than a dynamic outrigger) reported improved total active arc (21.6°→47.2°) and corrected ulnar deviation (30.4°→9.7°), suggesting the position held and active motion matter more than the specific splint mechanism [Burr/Massy-Westropp J Hand Ther 2002]. Weak (small prospective cohort).
  • The specific dynamic-splint protocol has not been shown superior to simpler regimes in controlled comparison. A randomised study found no clear added value of dynamic splinting over a simpler post-operative regime for MCP replacement, reinforcing that the dynamic outrigger is a sound, traditional default rather than a proven optimum [Delaney 2003]. Weak–moderate (small RCT).

Recovery trajectory (expected, evidence-anchored)

Phase Window Splint / position Hand-therapist focus Strength / load Notes
I — Dynamic extension splint + early controlled motion Week 0–~6 Dynamic extension outrigger worn day & night; MCPs in extension + slight radial deviation Controlled active MCP flexion within the splint (toward the surgeon's arc, often up to ~70°); active extension (correct extensor lag); radial-deviation re-education; free IP/wrist; oedema control Light unloaded use only; no grip/pinch, no ulnar load Capsule forms now — position held = position kept. Rheumatoid hands need the most diligent radial pull
II — Wean to night/rest splint, consolidate correction Week ~6–12 Wean dynamic splint → night/resting extension splint (longer at night in RA) Progress active/active-assisted flexion–extension out of splint, biased to extension + radial; scar massage once healed; preserve correction Still no strong grip/pinch; light functional tasks Recurrent ulnar drift is the main late failure — guard alignment
III — Strengthening & return Week ~12+ Night splint as indicated (esp. RA) Graded putty/ball grip and pinch, isometric MCP control, functional/task strengthening Begin grip strengthening ~8–12 wk, build gradually; coach non-ulnar-deviating grip Most everyday activity by ~3 months; alignment/comfort/arc settle over several more months

(Phase windows mirror the patient protocol; they are typical, heritage-based guides — not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Heritage regime, modest evidence. The Swanson-style dynamic extension outrigger with early controlled motion is deeply established and near-universally taught, but its supporting evidence is largely expert consensus and small/low-level studies. The defensible position is to follow the heritage regime faithfully while acknowledging its evidence tier [Goldfarb & Dovan 2006; Massy-Westropp Cochrane 2008]. Consensus.
  2. Which splint? Dynamic outrigger vs alternating static splints vs simpler regimes give broadly similar correction in small studies; CPM adds nothing. What matters is holding the MCPs in extension + radial deviation while moving early — the mechanism of the splint is secondary [Massy-Westropp Cochrane 2008; Burr 2002; Delaney 2003]. Weak–moderate.
  3. Rheumatoid vs osteoarthritis. The rheumatoid hand has ongoing deforming forces (tendon subluxation, intrinsic tightness, soft-tissue laxity) and recurs, demanding more prolonged radial-deviation/night splinting and joint protection; the osteoarthritic hand has better bone and soft tissue and a more durable correction [Morrell & Weiss 2018; Rizzo 2011]. Moderate.
  4. Realistic goals. The operation reliably delivers pain relief, corrected alignment and a functional arc, not a normal or powerful hand. Mis-set expectations (large grip gains) are a common source of dissatisfaction [Chung patient-expectations 2015; SARA cohort]. Moderate.
  5. Implant fracture ≠ failure. Radiographic implant fracture accrues over years but is frequently asymptomatic; revision is symptom-driven. Counsel accordingly rather than revising on imaging alone [Koenuma 2024; Wagner 2019]. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE–STRONG: silicone MCP arthroplasty improves deformity, alignment (ulnar deviation, extensor lag), MHQ and arc versus non-surgical care in severe rheumatoid MCP disease, durable to 7 years (SARA prospective cohort — comparative, not randomised).
  • MODERATE: correction-over-power outcome profile; favourable long-term OA results; time-related implant fracture (often asymptomatic); defined but uncommon revision rate; greater recurrence in rheumatoid than osteoarthritic hands.
  • WEAK / CONSENSUS / HERITAGE: the specific dynamic-extension-outrigger + early-controlled- flexion + radial-deviation rehabilitation programme (strong heritage, low-level evidence; CPM shown unhelpful; dynamic vs static vs simpler regimes not clearly differentiated); exact phase timings (typical, not trial-derived).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Kirschenbaum D, Schneider LH, Adams DC, et al. Arthroplasty of the metacarpophalangeal joints with use of silicone-rubber implants in patients who have rheumatoid arthritis. Long-term results. J Bone Joint Surg Am. 1993;75(1):3-12. DOI: 10.2106/00004623-199301000-00002
  • Goldfarb CA, Dovan TT. Rheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes. Hand Clin. 2006;22(2):177-188. DOI: 10.1016/j.hcl.2006.02.001
  • Rizzo M. Metacarpophalangeal joint arthritis. J Hand Surg Am. 2011;36(2):345-353. DOI: 10.1016/j.jhsa.2010.11.035
  • Morrell NT, Weiss AC. Silicone metacarpophalangeal arthroplasty for osteoarthritis: long-term results. J Hand Surg Am. 2018;43(3):229-233. DOI: 10.1016/j.jhsa.2017.10.010
  • Koenuma N, Ikari K, Oh K, et al. Long-term implant fracture rates following silicone metacarpophalangeal joint arthroplasty in rheumatoid arthritis. J Hand Surg Am. 2024. DOI: 10.1016/j.jhsa.2024.01.009
  • Wagner ER, Houdek MT, Packard B, et al. Revision metacarpophalangeal arthroplasty: a longitudinal study of 128 cases. J Am Acad Orthop Surg. 2019. DOI: 10.5435/JAAOS-D-17-00042
  • Carlson Strother CR, Moran SL, Rizzo M. Small joint arthroplasty of the hand: an update on indications, outcomes, and complications. J Am Acad Orthop Surg. 2023;31(15):e739-e749. DOI: 10.5435/JAAOS-D-23-00034
  • Blazar PE, Gancarczyk SM, Simmons BP. Rheumatoid hand and wrist surgery: soft tissue principles and management of digital pathology. J Am Acad Orthop Surg. 2019;27(21):e924-e933. DOI: 10.5435/JAAOS-D-17-00608
  • Naniwa S, Nishida K, Nasu Y, et al. A comparative study of short-term outcomes between INTEGRA and AVANTA silicone implants for metacarpophalangeal joints in patients with rheumatoid arthritis. J Hand Surg Am. 2026. DOI: 10.1016/j.jhsa.2026.04.003

MCP arthroplasty outcomes & rehabilitation literature (URLs)

  • Chung KC, Burns PB, Wilgis EFS, et al. A multicenter clinical trial in rheumatoid arthritis comparing silicone metacarpophalangeal joint arthroplasty with medical treatment. J Hand Surg Am. 2009;34(5):815-823. DOI: 10.1016/j.jhsa.2009.01.018 — https://pmc.ncbi.nlm.nih.gov/articles/PMC4381953/
  • Chung KC, Burns PB, Kim HM, et al. Long-term followup for rheumatoid arthritis patients in a multicenter outcomes study of silicone metacarpophalangeal joint arthroplasty. Arthritis Care Res (Hoboken). 2012;64(9):1292-1300. DOI: 10.1002/acr.21705 — https://pubmed.ncbi.nlm.nih.gov/22511483/
  • Burns PB, Zhong L, Chung KC. Seven-year outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) prospective cohort study. Arthritis Care Res (Hoboken). 2017. DOI: 10.1002/acr.23105 — https://pmc.ncbi.nlm.nih.gov/articles/PMC5376377/
  • Chung KC, Burns PB, et al. Patient expectations and long-term outcomes in rheumatoid arthritis patients: results from the SARA study. Clin Rheumatol. 2015;34(4):641-651. DOI: 10.1007/s10067-014-2775-z — https://pubmed.ncbi.nlm.nih.gov/25267562/
  • Massy-Westropp N, Johnston RV, Hill C. Post-operative therapy for metacarpophalangeal arthroplasty. Cochrane Database Syst Rev. 2008;(1):CD003522. DOI: 10.1002/14651858.CD003522.pub2 — https://pmc.ncbi.nlm.nih.gov/articles/PMC8715905/
  • Burr N, Pratt AL, Stott D. An alternative splinting and rehabilitation protocol for metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis. J Hand Ther. 2002;15(1):41-47. DOI: 10.1053/hanthe.2002.v15.01541 — https://pubmed.ncbi.nlm.nih.gov/11866351/
  • Delaney R, Trail IA, Nuttall D. Value of dynamic splinting after replacement of the metacarpophalangeal joint in patients with rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg. 2003;37(4):232-233. DOI: 10.1080/02844310310005658 — https://pubmed.ncbi.nlm.nih.gov/12755512/

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