Pyrolytic carbon humeral head in hemi-shoulder arthroplasty: preliminary results at 2-year follow-up

Abstract

Background In patients with osteoarthritis (OA) and an intact rotator cuff, hemi-shoulder arthroplasty (HSA) can be a viable option as it offers the advantage of keeping the native glenoid intact. However, glenoid erosion has frequently been reported. The aim of this study was to report preliminary clinical results of HSA with a new pyrolytic carbon (pyrocarbon) humeral head. Methods This prospective multicenter study included a continuous series of 65 patients who underwent pyrocarbon HSA in 5 centers. Results At the time of analysis, 1 patient was lost to follow-up, 3 patients underwent revision, and 61 patients were evaluated at a mean follow-up of 25.9 ± 3.3 months. The mean age at index surgery was 57.9 ± 13.3 years. The indications were primary glenohumeral OA in 37 patients, osteonecrosis in 11, secondary OA in 11, and rheumatoid arthritis in 2. The mean Constant score increased from 31.0 ± 15.8 points at baseline to 74.6 ± 17 points at last follow-up. Radiographic analyses showed that 86% of glenoids remained unchanged whereas 14% evolved slightly. Conclusions Pyrocarbon HSA grants improvement in pain and function in patients with primary OA or secondary OA after instability but at a lower level in patients with post-traumatic sequelae (secondary OA or osteonecrosis). These preliminary clinical and radiologic results are encouraging, although they need to be confirmed by longer-term follow-up observations.

RSA, TSA and PyC hemi-prostheses: comparing indications and clinical outcomes using a second-generation modular short-stem shoulder prosthesis

“…Our results equally are encouraging, with improvements in all areas of clinical function. With regard to results in the use for fracture sequelae, we had one patient operated with PyC for this indication, which yielded a poorer result than all other indications, adding weight to the conclusion drawn by Garret et al [ 23 ].…”

“…This material is thought to have a biomechanical profile close to that of cartilage and therefore is hoped to reduce the problem of glenoid wear and pain which complicate traditional hemiarthroplasties [ 8 ]. Preliminary results after implantation of these have been encouraging, except in patients with a diagnosis of fracture sequelae (osteonecrosis or secondary osteoarthritis), in a study containing some of the patients from our cohort [ 23 ]. Our results equally are encouraging, with improvements in all areas of clinical function.…”

Management of Painful Shoulder Arthroplasty: A Narrative Review

“…The use of innovative materials for humeral heads, such as pyrocarbon, which has an elastic modulus similar to cortical bone, seems to be the new frontier in the prevention of glenoiditis in shoulder hemiarthroplasty and preliminary clinical results appear to be encouraging [ 16 ].…”

“…c Implantation of hypoallergenic prosthetic components after synthesis of the humeral diaphysis with two titanium metal cerclages. d X-ray 1 year after revision with hypoallergenic RSA the new frontier in the prevention of glenoiditis in shoulder hemiarthroplasty and preliminary clinical results appear to be encouraging [16].…”

Reassessing the minimum two-year follow-up standard after total shoulder arthroplasty—Is one year sufficient?

“…1–6 While demand for shoulder arthroplasty has increased over the past two decades 3,7–12 there is a paucity of data tracking either the speed and process of recovery or the appropriate follow-up length. 13,14 It is likely that the investigational minimum follow-up of two-years for Investigation Device Exemption (IDE) studies 10,15 and peer-reviewed patient outcome-based studies is not grounded in literature involving shoulder arthroplasty-specific epistemology. This standard likely originated from hip and knee arthroplasty studies which suggest that patients continue to improve postoperatively through the two-year mark.…”