Pyrolytic carbon arthroplasty for the proximal interphalangeal joint: results after minimum 3 years of follow-up
St. Thomas Hospital, London, UK.The Journal of hand surgery, European volume 04/2012; 37(6):501-5. DOI: 10.1177/1753193412443044
A retrospective study was undertaken to review the outcomes of a consecutive series of patients treated using pyrocarbon surface replacement arthroplasty by the same surgeon. We analyzed the results of this procedure in 24 proximal interphalangeal (PIP) joints in 19 hands of 16 patients. The minimum follow-up was 3 years. The study showed that pyrocarbon PIP joint replacements provided excellent pain relief and high patient satisfaction. More than two-thirds of patients subjectively rated postoperative range of motion and functional outcomes as better than preoperatively. Objective assessment showed a modest improvement in the active range of motion, which did not achieve statistical significance, although we did observe a statistically significant increase in passive range of motion. The results are encouraging for those surgeons who seek an alternative to silicone implant PIP joint arthroplasty in high-demand patients.
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- "Les implants en pyrocarbone, dont l'utilisation a débuté en Europe, offrent des avantages par rapport à l'arthroplastie en silicone  et à l'arthrodèse . Plusieurs articles ont démontré sa fiabilité dans la réduction de la douleur [7,16–18] et l'amélioration de l'amplitude des mouvements   . Par contre, ses résultats ne sont pas vraiment prévisibles  et les taux de reprise des prothèses en pyrocarbone sont variables, allant de 6 % à 28 %    . "
ABSTRACT: Pyrolytic carbon prostheses are one of the options for the treatment of arthritis of the proximal interphalangeal (PIP) joint. Deficiency of the extensor mechanism, instability, dislocation and infection are the most frequent causes described for revision. We report the case of a female patient who underwent a PIP arthroplasty with a pyrolytic carbon implant of her right long finger; she suffered from an implant fracture only 11 months after surgery, a rare complication of this kind of implant; it makes think to fragility of this kind of implant.
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ABSTRACT: Proximal interphalangeal (PIP) joint arthroplasty remains an established surgical treatment option for the arthritic and painful PIP joint. A variety of materials have been used for arthroplasty including silicone, metal-plastic, and pyrolytic carbon. In addition, constrained and semiconstrained designs have been used. The constrained implants are more commonly indicated for patients with incompetent ligaments or poor soft-tissue stabilizers. A variety of surgical approaches have been proposed, including volar, dorsal, and lateral techniques. The volar approach is more commonly used with the silicone implants, as the more precise cuts for newer nonconstrained implants were designed with the instrumentation in mind for the dorsal approach. Outcomes of PIP joint arthroplasty generally reflect excellent pain relief. Arthroplasty does afford some mobility, as opposed to arthrodesis, of the PIP joint. However, range of motion after PIP joint replacement is less predictable and may not provide improvement compared with preoperative measures. Unfortunately, reoperation rates after PIP joint arthroplasty are not inconsequential, and salvage of failed arthroplasty options are limited and include (not uncommonly) arthrodesis. Thus, counseling of the patient regarding risk and benefits of the arthroplasty is critical in tempering expectations and helping the patient determine their best treatment.
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ABSTRACT: There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2-9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2-5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.
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