ਅੰਗੂਠੇ ਦਾ ਅਧਾਰ ਜੋੜ ਬਦਲਣਾ (ਟੱਚ) ਜਾਣਕਾਰੀ

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Topic scope: post-operative rehabilitation after a dual-mobility total joint replacement of the trapeziometacarpal (thumb base / CMC) joint for advanced thumb base osteoarthritis — the Touch implant. Unlike trapeziectomy, the trapezium is retained and thumb length preserved, and a correctly seated dual-mobility implant is immediately stable and load-sharing. The rehab is therefore a minimal-immobilisation, early-motion pathway: protect briefly against the implant-specific early dislocation risk, restore opposition within the first month, then load.

Defining principle of the rehab here: a trapeziectomy relies on a scar/haematoma "spacer" forming where the bone was removed, which takes roughly 12 months to mature — so rehab is slow by necessity. A dual-mobility thumb base replacement instead provides an immediately stable, load-sharing artificial joint, so immobilisation can be minimal, opposition is restored within the first month, and recovery is faster than trapeziectomy. The dual-mobility cup specifically reduces the early dislocation risk that drove longer immobilisation with older single-mobility implants. The one deliberate early restraint is therefore avoidance of forced/extreme thumb positions (the implant-specific dislocation risk) for the first few weeks, after which loaded pinch/grip strengthening begins. This is a newer implant: the evidence base is short-to-mid-term and low-to-moderate level, and rehab regimens are under-reported and not standardised.

A. PROCEDURE OUTCOMES (dual-mobility Touch TMC arthroplasty)

Dual-mobility total joint replacement of the thumb base is a comparatively new alternative to trapeziectomy for advanced trapeziometacarpal osteoarthritis. Early- to mid-term series report high implant survival and good restoration of pinch and function, with the principal trade-off being a higher complication/revision profile than the well-established trapeziectomy — though the dual-mobility design improves on the dislocation rate of earlier single-mobility implants.

• High short-to-mid-term implant survival and good function. A Touch-specific series reported 96% implant survival at 2 years with high key-pinch strength; the main adverse events were soft-tissue complications (de Quervain-type tenosynovitis, trigger digit) rather than implant failure [Herren 2023]. A 150-patient dual-mobility cohort similarly reports early normalisation of function. Moderate (case series / retrospective cohort).
• Faster recovery than trapeziectomy because the joint is immediately stable. Because the implant is load-sharing from the outset, the thumb is only briefly immobilised, patients return to near-normal activity early, and formal therapy may not always be required — contrasting with the ~12-month maturation of a trapeziectomy spacer [Duerinckx & Verstreken 2022]. Moderate (narrative review / cohort).
• Opposition and pinch/grip recover well. Using the MOOVIS dual-mobility implant, the Kapandji opposition score improved from 7 to 10 with improved pinch and grip [Dreant 2018]. Moderate (cohort).
• The dual-mobility design reduces dislocation. The extra articulation lowers the early dislocation risk that limited older single-mobility prostheses, supporting earlier mobilisation [Tchurukdichian 2019; Martins 2020]. Moderate (cohort / mechanistic).
• Lower reoperation than ball-and-socket designs; persistent revision risk overall. A network meta-analysis found dual-mobility implants had lower reoperation than ball-and-socket designs, with TOUCH reoperation around 1.0% [Burnett 2026 NMA]. Reported outcomes continue to evolve in ongoing reviews [Tosti & Duerinckx 2026]. Moderate (NMA of mostly observational data).
• Registry-level work-absence benchmark. Swedish registry data give a sense of real-world recovery: sick leave of roughly 94 days for men and 109 days for women — a benchmark to set realistic return-to-work expectations rather than a target. Moderate (registry).

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) how long to immobilise, and (2) when to start motion and loading. Because the implant is immediately stable, the modern answer is minimal immobilisation with early active opposition — but the literature is explicit that there is no consensus and wide variation between centres, and that rehab protocols are under-reported.

• Minimal immobilisation is justified by immediate stability. A correctly seated dual-mobility implant is stable and load-sharing, so prolonged casting is unnecessary; the thumb is briefly protected, then mobilised early, with opposition typically back within the first month [Duerinckx & Verstreken 2022]. Moderate (review).
• No standardised regimen — wide variation in immobilisation and motion timing. A dedicated review of immobilisation and rehabilitation after thumb-base arthroplasty found reported immobilisation ranging from 2 to 12 weeks and active range-of-motion commencing anywhere from 1 to 6 weeks, with no consensus across studies [Barrett 2022]. This is the key caveat for any protocol: the timings are a defensible, surgeon-confirmed plan, not a trial-derived standard. Moderate (systematic review of heterogeneous protocols).
• Early opposition recovery is achievable and is the functional priority. Improvement of the Kapandji opposition score (7→10) demonstrates that active opposition is the early rehab target and is realistically attainable in the first weeks-to-months [Dreant 2018]. Moderate (cohort).
• The early restraint is dislocation avoidance, not protected healing. The dual-mobility design reduces but does not abolish early dislocation; the practical implication is to avoid forced/extreme thumb positions in the first weeks rather than to immobilise for prolonged periods [Tchurukdichian 2019; Martins 2020]. Moderate / mechanistic.

Recovery trajectory (expected, evidence-anchored)

(Phase windows reflect KH-confirmed parameters and are consistent with the wide ranges reported in the literature; they are typical guides, not trial-derived deadlines — see Barrett 2022.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

1. Replacement vs trapeziectomy. Dual-mobility replacement restores the joint and gives a faster functional return (immediate stability, opposition back within a month) versus the ~12-month maturation of a trapeziectomy spacer, but at the cost of a higher complication and revision rate and a shorter evidence track record. Trapeziectomy remains the well-established, lower-risk benchmark. Moderate; trade-off, not a clear winner.
2. How long to immobilise / when to start motion. No consensus — reported immobilisation spans 2–12 weeks and AROM start 1–6 weeks [Barrett 2022]. This page's day-splint-2–3-weeks → night-splint-to-6-weeks → strengthen-from-6-weeks plan is a defensible, surgeon-confirmed regimen within that reported range, not a proven standard. Weak–moderate.
3. Dislocation risk. The dual-mobility cup reduces the early dislocation that limited older single-mobility implants, but the risk is not zero in the first weeks — hence the early forced/extreme-position restraint [Tchurukdichian 2019; Martins 2020]. Moderate / mechanistic.
4. Complication profile. Soft-tissue complications (de Quervain-type tenosynovitis, trigger digit) are the commonest early issues rather than implant failure [Herren 2023]; reoperation is low for dual-mobility (TOUCH ~1.0%) and lower than ball-and-socket designs [Burnett 2026 NMA]. Moderate.
5. Maturity of the evidence. This is a newer implant: outcomes are short-to-mid-term, evidence is low-to-moderate level (case series, retrospective cohorts, registry and NMA of mostly observational data), and rehabilitation is under-reported and not standardised. Tone should be appropriately cautious. Evidence base still maturing.

D. EVIDENCE STRENGTH FLAGS (summary)

• MODERATE (cohort / registry / NMA of observational data): high short-to-mid-term implant survival (96% at 2 yr, Touch) with good key-pinch; Kapandji opposition 7→10; dual-mobility lower reoperation than ball-and-socket (TOUCH ~1.0%); registry sick-leave benchmark (~94 d men / 109 d women); faster functional return than trapeziectomy.
• MODERATE (systematic review of heterogeneous protocols): no consensus on rehab — immobilisation 2–12 weeks, AROM start 1–6 weeks (Barrett 2022).
• WEAK / CONSENSUS: the specific immobilisation-then-early-opposition-then-strengthen phase timings (surgeon-confirmed, within the reported range; not trial-derived); the dislocation-avoidance rationale (mechanistic).
• CAVEAT: newer implant — short-to-mid-term, low-to-moderate-level evidence; higher complication/revision rates than trapeziectomy persist; rehab under-reported.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

• Duerinckx J, Verstreken F. Dual mobility prosthesis for trapeziometacarpal joint arthritis. EFORT Open Rev. 2022. DOI: 10.1530/eor-22-0027
• Herren DB, et al. Trapeziometacarpal joint replacement with the Touch prosthesis: two-year results. J Hand Surg (Eur Vol). 2023. DOI: 10.1177/17531934231179581
• Dreant N, et al. Trapeziometacarpal arthroplasty with the dual-mobility MOOVIS prosthesis. Hand (NY). 2018. DOI: 10.1177/1558944718797341
• Tchurukdichian A, et al. Dual-mobility implant reduces the dislocation risk in trapeziometacarpal arthroplasty. Hand (NY). 2019. DOI: 10.1177/1558944719855690
• Martins A, et al. Dual-mobility trapeziometacarpal prosthesis. J Hand Surg (Eur Vol). 2020. DOI: 10.1177/1753193420901435
• Barrett H, et al. Immobilization and rehabilitation after trapeziometacarpal joint arthroplasty: a review. J Hand Surg Glob Online. 2022. DOI: 10.1016/j.jhsg.2022.05.011
• Tosti R, Duerinckx J. Trapeziometacarpal total joint arthroplasty: current concepts. J Hand Surg Am. 2026. DOI: 10.1016/j.jhsa.2026.01.003
• Burnett K, et al. Implant designs for trapeziometacarpal arthroplasty: a network meta-analysis of reoperation. J Hand Surg Am. 2026. DOI: 10.1016/j.jhsa.2025.12.011

Thumb base arthroplasty literature (URLs)

• Herren DB, et al. TOUCH trapeziometacarpal prosthesis — two-year results. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12098211/
• Dual-mobility trapeziometacarpal arthroplasty — 150-patient cohort. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12662895/
• TOUCH prosthesis case series. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC8470025/
• KeriMedical — TOUCH thumb base prosthesis patient information. https://www.kerimedical.com/en/patients/