Pyrocardan® interpositional arthroplasty for trapeziometacarpal osteoarthritis: a minimum four year follow-up

Abstract

Background Pyrocardan® (Wright Medical-Tornier) is a pyrocarbon implant proposed in the treatment of trapeziometacarpal joint (TMCJ) osteoarthritis. Our aim was to assess the clinical and radiographic results after Pyrocardan® arthroplasty at midterm follow-up. Methods In this prospective monocentric study, we enrolled 119 patients treated with Pyrocardan® for TMCJ osteoarthritis and followed up at a minimum of four years. The clinical outcome was assessed through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Visual Analog Score (VAS) for pain and the Kapandji score collected pre-operatively, at three, six and 12 months, then yearly. Hand radiographs were taken before surgery, at three months and every year. Complications and re-operations were also recorded. Results The mean follow-up was 5.2 years (range, 4–9). DASH, VAS and Kapandji scores significantly improved at three (p < 0.001 in all cases) and six months (p < 0.001, p = 0.01 and p < 0.001, respectively), remaining stable over time. The dislocation and subluxation rates were 3.3% (4 cases) and 16.8% (20 patients), respectively. The two year, four year and seven year survivorship of the implant was 99%, 98% and 95%, respectively. Conclusion Pyrocardan® arthroplasty provides a satisfactory clinical and radiographic outcome for treating TMCJ osteoarthritis, with a 97% survival rate at four years. We advocate comparative studies with more common techniques (i.e., trapeziectomy) to verify its cost-effectiveness.

Pyrocarbon hemiarthroplasty and the shoulder: biomechanical and clinical results of an emerging treatment option

“…Nevertheless, some reports highlighted concerns for procedure-related complications, including postoperative arthritis, component loosening and dislocation, and nerve impingement [ 59 ]. As such, wide adoption of pyrocarbon implants has been limited to hand surgery, possibly due to its complication profile and higher costs [ 60 , 61 ]. Pyrocarbon implants have also been used in the lower limb, as reported by Bernasek et al [ 62 ], who conducted a pilot study of pyrocarbon hemiarthroplasty on two groups of patients diagnosed with either hip fracture or femoral head osteonecrosis.…”

Transosseous Cannula Suture Suspensionplasty for Thumb Basal Joint Arthritis: A Novel Technique

“…Step 7: Under fluoroscopic guidance, two 1.0-mm diameter K-wires positioned between the proximal dorsoulnar metaepiphyseal margin of the second metacarpal bone and the volar radial base of the first metacarpal bone were inserted crosswise at the level of the surgical incision and along the first metacarpal ligament transition zone (Figs. 10,11).…”

“…After partial or complete trapeziectomy, the first metacarpal tends to subside into the newly created space 3 . Different types of metacarpal stabilization procedures have been used to obviate the risk of metacarpal subsidence, such as ligament reconstruction with or without tendon interposition (LRTI), 4,5 hematoma and distraction arthroplasty, 6 suspensionplasty, 7 and total or hemi-implant arthroplasty 8–10 . These techniques have their own potential complications, such as stiffness, long recovery time, tendon adhesion or rupture, and pin-related complications 2,4–9 .…”

“…3 Different types of metacarpal stabilization procedures have been used to obviate the risk of metacarpal subsidence, such as ligament reconstruction with or without tendon interposition (LRTI), 4,5 hematoma and distraction arthroplasty, 6 suspensionplasty, 7 and total or hemi-implant arthroplasty. [8][9][10] These techniques have their own potential complications, such as stiffness, long recovery time, tendon adhesion or rupture, and pin-related complications. 2,[4][5][6][7][8][9] The suture button (SB) suspension technique was subsequently proposed to provide an internal means of metacarpal stabilization.…”