Long-Term Follow-up of Pyrolytic Carbon Metacarpophalangeal Implants*

Guidelines for the management of rheumatoid arthritis: 2002 Update

“…Surgical procedures for RA include carpal tunnel release, synovectomy, resection of the metatarsal heads, total joint arthroplasty, and joint fusion. New prosthetic materials and cements for fixing joint prostheses have greatly advanced the prevention of aseptic loosening and have increased the longevity of total joint prostheses in patients with RA (138)(139)(140)(141)(142).…”

A 10-Year Follow-Up of Uncemented Constrained Metacarpophalangeal Joint Arthroplasties Using the RM Prosthesis in a Patient with Rheumatoid Arthritis.

“…Despite distinctive radiographic loosening and subsidences of all 4 implants, 3 implants are well functioning with a satisfactory outcome in a RA patient with high-demand activities of daily living. This feature (discrepancy between radiographic findings and good subjective results and without necessity of surgical revision in the absence of clinical symptoms) is known from the use of the silicone rubber and pyrocarbon implants [4,6,8,16,17,31]. However, due to the absence of larger case series with long-term follow-up's in the literature, it cannot be concluded that the RM prosthesis is really a reliable option for treatment of RA affecting the MCPJs.…”

“…The new generation of MCPJ arthroplasty is unconstrained surface replacement either with pyrocarbon prostheses [8,31,32] or prostheses with a metal-on-polyethylene (PE) articulation [33,34]. The goal of these prostheses is that they are low profile, anatomically designed implants limit the amount of bone removed [35].…”

“…However, in comparison to the use of constrained MCPJ arthroplasty with the RM prosthesis, long-term results with the use of the SR TM MCPJ resurfacing arthroplasty could not be found in the literature as well. The longterm survival rate for resurfacing pyrocarbon MCPJ arthroplasty is reported to be 81, 4% [8]. …”

“…The constrained MCPJ arthroplasty was designed to decrease the risk of recurrence of palmar (sub) luxation and ulnar deviation postoperatively due to the inherent lack of ligamentous support that was found in up to 31% of patients with RA who underwent a silicone rubber implant arthroplasty [5]. However, the rates of loosening and mechanical failure of almost all types of constrained prostheses are so high that their use cannot be recommended at present [6]; and the role of the piston effect, primarily known from the silicone rubber implant that increases the range of motion of the proximal phalanx , for breakage of prosthesis in cases of loosened nonsilicone uncemented MCPJ implants such as in unconstrained resurfacing pyrocarbon arthroplasty [8,9] or in constrained arthroplasty such as in our following case presentation, is not clearly understood currently. The second generation of the constrained and uncemented MCPJ RM prosthesis (Mathys, Bettlach, Switzerland) is one type that is in use [10].…”