“…Odella et al had 12% of patients report worsening pain and 2 patients underwent revision surgery, 51 while Lauwers et al revised four patients to a trapeziectomy for persistent pain. 50 In our series, while nine patients reported mild pain on activity as a persisting symptom up to 12 months postoperatively, none have required further intervention or revision surgery to date. In keeping with our experience of pyrocarbon as a bearing surface for hemiarthroplasty in other joints, pain relief continues to improve beyond 12 months.…”
Section: Discussionmentioning
confidence: 57%
“…They hypothesized that this variation in technique might account for the disparity between their and Bellemère's results. 50 Our technique is similar though not identical to Bellemère's. The dorsal capsular arthrotomy allows differential tensioning and robust capsular repair to account for preoperative subluxation.…”
Section: Discussionmentioning
confidence: 77%
“…Lauwers et al reported on two patients with dislocation of Pyrocardan implants in a series of 27 cases. 50 They performed the surgery through a volar approach using a tendon graft to reinforce the capsule repair. They hypothesized that this variation in technique might account for the disparity between their and Bellemère's results.…”
Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI.
Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible.
Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants.
Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI.
Level of Evidence This is a Level III, prospective observational cohort study.
“…Odella et al had 12% of patients report worsening pain and 2 patients underwent revision surgery, 51 while Lauwers et al revised four patients to a trapeziectomy for persistent pain. 50 In our series, while nine patients reported mild pain on activity as a persisting symptom up to 12 months postoperatively, none have required further intervention or revision surgery to date. In keeping with our experience of pyrocarbon as a bearing surface for hemiarthroplasty in other joints, pain relief continues to improve beyond 12 months.…”
Section: Discussionmentioning
confidence: 57%
“…They hypothesized that this variation in technique might account for the disparity between their and Bellemère's results. 50 Our technique is similar though not identical to Bellemère's. The dorsal capsular arthrotomy allows differential tensioning and robust capsular repair to account for preoperative subluxation.…”
Section: Discussionmentioning
confidence: 77%
“…Lauwers et al reported on two patients with dislocation of Pyrocardan implants in a series of 27 cases. 50 They performed the surgery through a volar approach using a tendon graft to reinforce the capsule repair. They hypothesized that this variation in technique might account for the disparity between their and Bellemère's results.…”
Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI.
Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible.
Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants.
Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI.
Level of Evidence This is a Level III, prospective observational cohort study.
“…The main benefit of using an interposition arthroplasty is the maintenance of length of the first ray. Furthermore, it can easily be revised by a trapeziectomy with or without LRTI in the case of failure [78,79]. Pyrocardan ® implants can also be used as a double arthroplasty in the TMC and STT joints in patients with stage IV osteoarthritis, or as an interposition spacer after failed trapeziectomy with subsidence [80].…”
Osteoarthritis of the trapeziometarcarpal joint, also called rhizarthrosis, is a common finding in the second half of life. It has a higher prevalence in females and is of growing importance in ageing societies. A variety of conservative and surgical treatment options are known, including conservative treatment up to joint replacement. Without treatment, rhizarthrosis can lead to disabling pain and loss of hand function. The goal of this overview of treatment options is to present a stepwise approach that can be initiated by any physician.Treatment of trapeziometacarpal osteoarthritis should be started early with conservative measures such as splinting and physical therapy, which can be supplemented by oral and topical analgesics and local infiltrations subsequently. If all of these interventions do not provide sufficient relief, referral to a hand surgeon should be considered.Surgical strategies vary from arthroscopic debridement over trapeziectomy, with or without tendon interposition and ligament reconstruction, to interposition implants and total joint replacements. The planned intervention should be based on clinical and subjective functional limitations and associated degenerative changes, as well as the patient's expectations and needs.The goal of this paper is to develop a treatment algorithm, leading to higher levels of patient functionality and satisfaction. Below we discuss the current literature and point out key treatment options used in our department.
Additional imagingMultilayer imaging can help to evaluate the trapeziometacarpal joint and the neighbouring joints in more detail. To evaluate bone stock and cartilage surfaces, and especially if planning prosthetic implants, computed tomography (CT) enhanced by intra-articular contrast injection can be useful [18]. Magnetic resonance imaging (MRI) allows ligament and soft tissue evaluation. Recent
“…Favourable results with the Pyrocardan have been also achieved by others (Erne et al., 2017; Russo et al., 2016). Good outcomes require a learning curve (Lauwers et al., 2016; Odella et al., 2015). Figure 6.Pyrocardan implant in TMC joint for OA in a 47-year-old manual worker.…”
Section: Tmc and Scaphotrapeziotrapezoidal (Stt) Implantsmentioning
The article reviews the techniques and surgical outcomes of arthroplasties of the metacarpophalangeal, carpometacarpal and the wrist joints. In my patients, interposition pyrocarbon implants quickly achieve functional recovery and do not deteriorate time. Bony and articular tolerances are remarkable. These implants are a valid alternative to conventional arthroplasties, such as trapeziectomies, silicone implants and total joint replacements. Because of the implant’s small size, the surgery can be done through minimally invasive approaches especially for young and active patients. A technical key is to properly manage the bone surfaces of the joint and the peri-articular soft tissues to avoid early implant instability.
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