Pyrolytic carbon proximal interphalangeal joint resurfacing arthroplasty
ABSTRACT To evaluate the clinical results of a pyrolytic carbon resurfacing proximal interphalangeal joint (PIPJ) arthroplasty in patients with osteoarthritis.
A retrospective review of 18 PIPJ arthroplasties in 8 women with severe osteoarthritis performed by a single surgeon was completed with an average follow-up period of 13 months. Clinical assessment included range of motion (ROM), stability, and deformity. Radiographs were reviewed for evidence of loosening, subsidence, fracture, and osseointegration. Six patients, representing 16 joints, answered a questionnaire regarding pain relief, appearance, and overall satisfaction with the arthroplasty. Complications also were recorded.
The average preoperative ROM was 10 degrees to 63 degrees, and the average postoperative ROM was 18 degrees to 71 degrees. Although the average arc of motion was unchanged, 9 joints had an increase in ROM and 9 joints had a decrease in ROM. All joints were stable laterally. Radiographic review indicated 2 joints with loosening at 4 months after surgery. Complications included 8 squeaky joints, 5 joint contractures, and 2 dislocations. Pain was relieved completely in 8 joints, and the pain rating on a visual analog scale was 3.6 out of 10 for the 8 patients who had residual pain. Patients were satisfied completely with the results of 9 joints. Although there was residual deformity in 4 joints, patients believed that 15 of 16 joints had improved in appearance. Five of 6 patients responded that they would have the surgery again. There have been no secondary procedures performed by us.
The insertion of pyrolytic carbon implants for PIPJ arthroplasty is a technically demanding procedure, but it has the potential to achieve pain relief, stability, satisfactory ROM, and correction of the deformity; however, the results in this review were unpredictable and may not be superior to those achieved with other methods of arthroplasty.
Therapeutic, Level IV.
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ABSTRACT: We evaluated the outcome of pyrocarbon arthroplasty for proximal interphalangeal joint osteoarthritis in 18 arthroplasties carried out by a single surgeon using the Ascension prosthesis (Ascension Orthopedics Inc., Austin, Texas) in 15 patients after a mean of 6.2 years. Significant and maintained improvements in pain scores at rest and on active movements were achieved for surviving implants, and the range of motion was comparable with preoperative measurements. The radiographs, which were evaluated for evidence of ongoing migration and potential failure, were of concern in 10 out of 18 joints. Two patients required implant removal.02/2012; 37(6):497-500. DOI:10.1177/1753193412437630
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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: Surface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone-implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results.Indian Journal of Plastic Surgery 05/2011; 44(2):317-26. DOI:10.4103/0970-0358.85353