Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes

Abstract

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.

Pyrocardan Scaphotrapeziotrapezoid Joint Arthroplasty for Isolated Osteoarthritis: Results after a Mean Follow-Up of 5 Years

“…In our particular case, insufficient bone resection seems to be the cause of the dislocation, medially constraining the implant, with a tendency to expel it laterally. In the TM location, Gerace et al 19 and Logan et al 20 did not find any dislocation using the Pyrocardan implant. With the STPI implant, several cases of dislocation have been described whether in open surgery or under arthroscopy.…”

“…The Pyrocardan implant (Stryker, Wright Medical Tornier, Montbonnot Saint Martin, France) has been proposed as a treatment for TM and STT OA. 19 20 21 For the STT joint, the aim of this implant is to maintain the stability of the scaphoid by sparing the ligament attachments but also by preserving physiological kinematics and load transmission. Encouraging functional and radiological outcomes were reported at a short-term follow-up.…”

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

“…A few previous studies have investigated the efficacy of Pyrocardan® to treat TMCJ osteoarthritis [7,[11][12][13][18][19][20] (Table 4). In these studies, authors have already outlined the advantages related to Pyrocardan®, i.e.…”

“…While its biconcave surfaces would convert the saddle joint of the TMCJ into a cardan one, its structure in pyrocarbon would be theoretically advantageous given the elastic module similar to cortical bone [6,[8][9][10]. Encouraging results have been reported at over two years from surgery [11,12], and only one study has documented a 96% survival rate at five years from surgery [13].…”

Retrospective review of pyrocarbon radial head replacement

“…This may be important in minimizing capitellar wear. It is durable and has been utilized in other arthroplasty, such as shoulders and fingers 16 .…”