Article

A Prospective, Randomized Comparison of 3 Types of Proximal Interphalangeal Joint Arthroplasty

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany
The Journal of hand surgery (Impact Factor: 1.67). 09/2012; 37(9):1770-9.e1-3. DOI: 10.1016/j.jhsa.2012.06.006
Source: PubMed

ABSTRACT

For surface replacement arthroplasty in proximal interphalangeal joint osteoarthritis, titanium-polyethylene (TI) and pyrocarbon (PY) implants are frequently used. However, their superiority in comparison to the silicone (SI) spacer has not been established. The purpose of this study was to compare these 3 types of implants with regard to outcome.
A prospective, randomized, multicenter trial was performed. A total of 43 patients (62 proximal interphalangeal joints) had surgery in the 3 participating centers, and each patient was randomly allocated to one of the 3 groups (TI, PY, SI). Range of motion (ROM) and strength were measured before surgery; pain and disability self-assessment and radiographic analysis were also completed. The same examination protocol was planned for 3 months, 6 months, and 1, 2, and 3 years after surgery, but some follow-up visits did not take place due to patient death or poor compliance.
The mean follow-up time at the final follow-up was 35 ± 3 months (range, 30-41 mo). All implant types led to significant pain reduction at rest and at load. Tip pinch strength was slightly improved by all 3 devices at the 3-year follow-up. No significant improvement in ROM for silicone or resurfacing implants was found. However, when comparing the highest ROM values reached after surgery, the resurfacing devices tended to show superior joint motility compared to silicone spacers, albeit only temporarily and not significantly. Sixteen explantations were necessary: 2 of 18 SI (11%), 7 of 26 TI (27%) and 7 of 18 PY (39%) implants had to be removed. An additional 4 secondary surgical procedures were performed in group TI.
Surface replacement arthroplasty devices showed a tendency for a temporarily superior maximum postoperative ROM, but markedly higher postoperative complication and explantation rates were observed compared to the silicone spacer implantation.

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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 [15] et à l'arthrodèse [16]. Plusieurs articles ont démontré sa fiabilité dans la réduction de la douleur [7,16–18] et l'amélioration de l'amplitude des mouvements [15] [18] [19]. Par contre, ses résultats ne sont pas vraiment prévisibles [9] et les taux de reprise des prothèses en pyrocarbone sont variables, allant de 6 % à 28 % [6] [7] [8] [9]. "
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    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.
    No preview · Article · Dec 2013 · Chirurgie de la Main
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    ABSTRACT: To report the outcome and complications from pyrocarbon proximal interphalangeal (PIP) joint arthroplasty at a minimum of 2 years of follow-up. A retrospective case review was performed on 72 patients with an average age of 57 years, and a total of 97 pyrocarbon PIP joint arthroplasties. Patient demographics, diagnosis, implant revisions, and other repeat surgeries were recorded. Subjective outcome was evaluated at latest follow-up with the Disabilities of the Arm, Shoulder, and Hand score; Patient Evaluation Measure; and visual analog scores of pain, satisfaction, and appearance. Objective outcomes included PIP joint range of motion, grip strength, and radiographic assessment of alignment and loosening. The principal diagnosis was primary osteoarthritis in 43 patients(60%), posttraumatic arthritis in 14 (19%), rheumatoid arthritis in 9 (13%), and psoriatic arthritis in 6 (8%). The average follow-up was 60 months (range, 24-108 mo). Twenty-two of 97 digits (23%) had repeat surgery without revision, and 13 digits (13%) had revision at an average of 15 months. There were no significant differences in preoperative and postoperative range of motion. The average Disabilities of the Arm, Shoulder, and Hand score was 22, and the average pain score was zero. Implant migration and loosening was observed but was not related to clinical outcome or revision. The survival of pyrocarbon PIP joint arthroplasty was 85% (83 of 97) at 5 years of follow-up, with high patient satisfaction. Patients should be advised that the procedure achieves good relief of pain but does not improve range of motion. Therapeutic IV.
    No preview · Article · May 2012 · The Journal of hand surgery
  • [Show abstract] [Hide abstract]
    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 submitted to PIP arthroplasty with a pyrolytic carbon implant of her right long finger, who 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 implants.
    No preview · Article · Jan 2013 · Chirurgie de la Main
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