Outcomes of Pyrolytic Carbon Arthroplasty for the Proximal Interphalangeal Joint at 44 Monthsʼ Mean Follow-Up

Abstract

Background Short-term results after proximal interphalangeal joint (PIPJ) arthroplasty with pyrolytic carbon (pyrocarbon) implant have shown that this implant suffers from high rates of complications; however patient satisfaction is high. The aim of this study is to evaluate the effectiveness of the pyrocarbon implant for use in PIPJ at a minimum 2 years follow-up. Methods Thirteen consecutive candidates who underwent 21 PIPJ arthroplasty with pyrocarbon implant were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire (MHQ) were administered preoperatively and at 12-months, and intermediate-term (>2 years) postoperatively. Preoperative and intermediate-term mean data for all functional measures and MHQ scores were compared. Results A total of 13 patients were treated in this study with a mean follow-up of 44 months. Grip strength, key pinch strength, and active arc of motion demonstrated no statistical difference between pre-operative and intermediate-term assessment. All domains of the MHQ showed improved large effect size at intermediate-term follow-up, especially Pain and Satisfaction. There were 10 complications in 9 joints (42.9% complication rate). Patients without complications had better functional outcomes, however there were no statistical differences in MHQ scores between patients with and without complications except for Pain (p=0.04). Conclusions PIPJ arthroplasty with pyrocarbon implant seems to be an effective way of reducing pain without sacrificing active arc of motion. Despite a high rate of complications, patients generally were satisfied, especially with pain relief. Additionally, complications do not affect patients’ satisfaction even if hand function was affected. Further decision-making analysis to compare arthroplasty and fusion for each finger may help surgeons to select the appropriate operative procedures. Levels of Evidence Therapeutic IV

A Systematic Review of Different Implants and Approaches for Proximal Interphalangeal Joint Arthroplasty

“…Postoperative grip and pinch strength improved regardless of the type of implant and surgical approach, 13,20,33,36–41 however, one study reported a decrease in grip strength from preoperative 21 kg to 17kg at 10years follow-up. 42 …”

A Modular Surface Gliding Implant (CapFlex-PIP) for Proximal Interphalangeal Joint Osteoarthritis: A Prospective Case Series

“…12e14 In addition, implant revision remains challenging because most implants require generous bone resection including partial or full release of the collateral ligaments. 15,16 In order to address these limitations, a modular prosthesis for PIP joint arthroplasty (CapFlex-PIP; KLS Martin Group, Tuttlingen, Germany) was developed to offer primary solid bone anchorage with limited bone resection and improved lateral joint stability as a result of the implant's anatomical congruent joint surfaces and because collateral ligaments are preserved during implantation. This pilot investigation aimed at evaluating the clinical and patient-rated outcomes with this new surface gliding implant one year after surgery.…”

Advances in Small Joint Arthroplasty of the Hand

“…Further, explantations were performed in 39% of pyrocarbon versus 11% of silicone arthroplasties. Other authors have reported squeaky joints, infection (54), and joint contractures (55) after pyrocarbon implant arthroplasty.…”