Medium- and long-term outcomes for hand and wrist pyrocarbon implants

Bellemère, P.

doi:10.1177/1753193419871671

Cited by 19 publications

(15 citation statements)

References 26 publications

(15 reference statements)

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“…Interposition implants such as silicone, pyrocarbone, autologous, allografts and synthetic materials combined with distal pole excision might be an option for the treatment of a primary degenerative ST joint in absence of DISI. In our case these options should be avoided as they have already failed, and would increase further carpal instability (Bellemère, 2019; Garcia‐Elias, 2011; Pequignot et al, 2005). As significant bone loss and scaphoid height were already present, further debridement would not be an option as literature demonstrates that scaphoid height loss of over 3 mm leads to further carpal instability (Obert et al, 2021).…”

Section: Discussionmentioning

confidence: 87%

Free vascularized second metatarsophalangeal joint transfer for scaphotrapezial joint reconstruction after distal scaphoid excision and carpal collapse: A case report

Piñal¹,

Cromheecke

Chaves³

2021

Microsurgery

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Treatment of the destroyed scaphotrapezial (ST) joint in young patients is challenging due to the limited available options as they might not tolerate the stiffness, loss of grip strength and long-term complications of partial fusions, bone resections, and interposition implants or arthroplasties. This report presents the results of a free osteocutaneous joint transfer used to reconstruct the ST joint in a young patient suffering from ST destruction and carpal collapse. This 34-year-old patient was previously treated for a right scaphoid nonunion with distal scaphoid excision and interposition implant that evolved to destruction of the ST space, symptomatic carpal collapse associated and a ST height loss of 7 mm. The DASH score was 34 and the grip strength of 32 kg. The patient was treated with an osteocutaneous vascularized free transfer from the second metatarsophalangeal joint vascularized by the first dorsal metatarsal artery and anastomosed to the palmar carpal branch of the radial artery and a palmar superficial vein. After 3.5 months, the patient returned to full duty work as a mechanic. At the last follow-up, 3 years after the surgery, the patients had complete range of motion without clinical nor radiological degenerative changes. There

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Section: Discussionmentioning

confidence: 87%

Free vascularized second metatarsophalangeal joint transfer for scaphotrapezial joint reconstruction after distal scaphoid excision and carpal collapse: A case report

Piñal¹,

Cromheecke

Chaves³

2021

Microsurgery

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“…Our review of all pyrocarbon interposition arthroplasty of the wrist and hand also found stable outcomes over time in the medium and long terms. 36 Another alternative for the treatment of advanced stages of wrist destruction is proximal row carpectomy with a resurfacing capitate pyrocarbon implant (RCPI). Most studies [37][38][39][40] reported very few cases with a limited follow-up.…”

Section: Discussionmentioning

confidence: 99%

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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Background Amandys is a pyrocarbon interposition implant used as a therapeutic alternative to total wrist fusion (TWF) or total wrist arthroplasty (TWA) in painful and disabling extensive destruction of the wrist. Objective To review mid-term outcomes in a continuous prospective series of patients who underwent wrist arthroplasty Amandys with a minimum follow-up of 5 years. Methods Clinical evaluation included a satisfaction survey, pain, two functional scores, the short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Rated Wrist Evaluation (PRWE), active wrist mobility, and grip strength compared with the contralateral side. Radiological evaluation was used to detect implant subsidence, carpal migration, bone lysis, or implant malposition. All per- and postoperative complications were collected. Results Fifty-nine patients (63 procedures) were evaluated with a mean follow-up of 7 years; 57% of the patients were males, and the mean age was 58 years. Among the patients, 90% were satisfied or very satisfied. Pain was significantly improved, with a gain of 4/10 (p < 0.001). Functional outcomes also improved between the second and fifth year of follow-up. Active mobility was preserved and grip strength was significantly improved by 7 kg (p < 0.001). No implant subsidence or carpal migration was observed. Ten patients (11.9%) underwent revision surgery for conflict (1%), rotation (6%), or implant dislocation (5%). All complications and revisions occurred early with no new events after 1 year of follow-up. Discussion Mid-term clinical and radiological outcomes were stable with improvement of functional scores. The survival rate was comparable to that reported for TWF with conserved mobility. We report fewer complications compared with those reported for TWA or TWF. Early instability of the implant was the main etiology of the revisions. Repositioning of the implant was successful. No conversion to TWA or TWF was necessary. Conclusions Mid-term outcomes of the Amandys implants were encouraging. Patients conserved good wrist motion with improved strength and functional scores. The implant was well tolerated. Functional outcomes continue to improve with the follow-up. The survival rate remains stable after 2 years. The level of evidence of this study is IV (therapeutic case series).

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“…Pyrocarbon implants are being increasingly used in the hand and wrist, particularly for carpal arthritis. 30 The biomechanical properties of pyrocarbon make it ideal for small joint arthroplasty in the hand and wrist. 31 With a similar modulus of elasticity to bone, excellent wear characteristics and good biocompatibility with bone and cartilage pyrocarbon implants are ideal to use when situating adjacent to Outcomes from the RCPI have demonstrate a flexionextension arc range of 55 to 82 with a grip strength range of 16 to 38 across six studies.…”

Section: Capitate Resurfacingmentioning

confidence: 99%

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

et al. 2022

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Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria—10 studies (n = 147) on CI and 8 studies on CR (n = 136). PRC with CI had the greatest flexion–extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

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Medium- and long-term outcomes for hand and wrist pyrocarbon implants

Cited by 19 publications

References 26 publications

Free vascularized second metatarsophalangeal joint transfer for scaphotrapezial joint reconstruction after distal scaphoid excision and carpal collapse: A case report

Free vascularized second metatarsophalangeal joint transfer for scaphotrapezial joint reconstruction after distal scaphoid excision and carpal collapse: A case report

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

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