Pyrocarbon versus Silicone Proximal Interphalangeal Joint Arthroplasty: A Systematic Review
ABSTRACT : Arthritis at the proximal interphalangeal joint can be a disabling chronic condition. Silicone arthroplasty is a common surgical treatment option to provide pain relief and maintain joint mobility. Pyrocarbon implants are gaining popularity as an alternative to silicone prostheses. The purpose of this systematic review is to compare the outcomes of silicone and pyrocarbon arthroplasties for patients with proximal interphalangeal joint arthritis.
: A computerized search was conducted to identify studies evaluating outcomes of silicone and pyrocarbon arthroplasties. The data extracted were patient demographics, pain relief, range of motion, grip and pinch strength, costs, quality of life, and complications.
: Thirty-five relevant citations were identified. Available data showed that both arthroplasties offered satisfactory pain relief. The implants also provided similar postoperative weighted mean arcs of motion, with a value of 37.4 ± 13.6 degrees for silicone and 44.8 ± 16.8 degrees for pyrocarbon. There were comparable results in grip and pinch strengths as well. No studies were identified that performed an economic analysis of arthroplasty. Six studies assessed quality-of-life outcomes after pyrocarbon surgery, and results were mixed. The rates of revision and salvage procedures performed secondary to complications were higher after pyrocarbon arthroplasty.
: Based on the available low level of evidence, pyrocarbon arthroplasty does not demonstrate clear superiority over silicone implants. In fact, there is concern about the complication rates of these implants. Future studies should focus on more rigorous study designs using validated quality-of-life scales and economic evaluations before widespread adoption of this new implant.
: Therapeutic, IV.
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ABSTRACT: The traumatized hand often has soft tissue loss requiring flap reconstruction. Before proceeding with flap selection, the need for future refinement and secondary surgery should be taken into consideration. Although muscle flaps may offer better contour, fasciocutaneous flaps allow easier secondary flap elevation. After the initial flap reconstruction, indications for secondary procedures may be managed according to tissue type: bone, joint, tendon, nerve, and soft tissue.Hand clinics 05/2014; 30(2):211-223. DOI:10.1016/j.hcl.2014.01.004 · 0.69 Impact Factor
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ABSTRACT: To evaluate the long-term results of proximal interphalangeal (PIP) joint surface replacement arthroplasty for arthritis using the SR PIP implant (Small Bone Innovations, New York, NY). This is a long-term retrospective analysis of results in 39 of 43 joints first reported in 2008. Subjective results were based upon a mailed questionnaire. Active range of motion was measured by a certified hand therapist, and x-rays were obtained to analyze changes occurring since the first study. The average follow-up time was 9.3 years. The average active PIP joint arc of motion in the present cohort of patients went from 64° at the first report (2008) to 56° at this time. Radiographic comparisons revealed no major changes since the first study. Ten of 11 revisions were done for pain due to loosening and were performed at an average of 20 months after the primary procedure. No further revisions were necessary in the interim. Overall, subjective measures of satisfaction and symptomatic and functional improvement remained unchanged. Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint. Long-term subjective and objective outcomes are comparable to those reported using other implants. This and other studies suggest that this procedure is not appropriate for most rheumatoid joints. In the interim between studies, we saw a reduction in the average PIP joint arc of motion, although this change did not reach statistical significance. Our original revision incidence of 26% has not changed. Subjective evaluation and radiologic findings did not change between studies. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.The Journal Of Hand Surgery 01/2015; 40(3). DOI:10.1016/j.jhsa.2014.11.015 · 1.66 Impact Factor
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ABSTRACT: To evaluate the short-term clinical and radiographic outcome of a silicone proximal interphalangeal (PIP) joint implant using a volar approach in patients with primary osteoarthritis. We retrospectively reviewed 36 proximal PIP joints that were replaced with Avanta silicone implants in 26 patients. Inclusion criteria were diagnosis of primary osteoarthrtitis of the PIP joint and failure to respond to conservative treatment. Clinical asessment included range of motion, patient satisfaction, and pain scores. The Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire was administered at final follow-up. Radiographs were reviewed for alignment and implant fracture. Complications were also recorded. After an average follow-up of 18 months (range, 12-60 mo), pain relief was markedly reduced in all patients, decreasing from a mean score of 7.2 preoperatively to 0.4 postoperatively. The arc of active motion of the PIP joint improved from 33° to 72°. Satisfaction averaged 4.8 on a 5-point Likert scale, and all patients stated they would repeat the surgery. The median final average Quick-Disabilities of the Arm, Shoulder, and Hand score was 7 (range, 4-12). Radiograph review showed 2 implant fractures at 1 and 2 years after surgery, respectively, but without clinical changes. The average deformity in the coronal plane changed from 12° (range, 8° to 18°) preoperatively to 4° (range, 3° to 8°) postoperatively, whereas the average flexion contracture changed from 18° (range, 10° to 30°) to 0° (all patients achieved full active extension). No other complications were observed. No revision surgery has been needed to date. The volar approach to PIP joint silicone arthroplasty offers the advantages of maintaining the integrity of the extensor mechanism, providing pain relief, and improving postoperative range of motion with minimal complications. However, further research is needed to determine the long-term efficacy of this implant. Therapeutic IV.The Journal of hand surgery 05/2014; DOI:10.1016/j.jhsa.2014.03.033 · 1.33 Impact Factor