Outcomes of Pyrolytic Carbon Arthroplasty for the Proximal Interphalangeal Joint

Author(s): Chung KC, Ram AN, Shauver MJ

Source: Plast Reconstr Surg 123: 1521-32, 2009.

Summary:

This article assesses the prospective outcomes and complication rates of a consecutive series of patients undergoing proximal interphalangeal joint arthroplasty using the pyrocarbon implant.  Fourteen patients treated with 21 implants were enrolled in the study and underwent proximal interphalangeal joint arthroplasty with pyrolytic carbon implants.  At the 12-month follow-up, mean active arc of motion was 38 degrees, which was slightly decreased from the preoperative value. Mean grip strength improved by 4 Kg, although the difference was not statistically significant. Mean key pinch values improved significantly by 3 Kg.   The Jebsen-Taylor test scores showed improvement, although not significantly. Changes in all Michigan Hand Outcomes Questionnaire domains showed a large effect size.

Three patients experienced squeaking of the implant and three patients experienced dislocation of the pyrocarbon joint.  The authors conclude that patient satisfaction and pain relief improved by pyrocarbon implant proximal interphalangeal joint arthroplasty.  However, there were complications related to implant dislocations, which required prolonged treatment with external fixators.

Treatment of proximal interphalangeal joint arthritis remains a challenge for hand surgeons. Current treatment choices include medication, arthroplasty, and fusion. 

Pyrolytic carbon implants are the latest technology in the field and this is one of the few prospective studies to evaluate the outcomes and complication rates of pyrolytic carbon arthroplasty of the proximal interphalangeal joint.   Because of the tenuous ligamentous support of the joint, this unlinked, hinge-type implant is a demanding procedure with complex technical sequences. The article reveals the same short-term complications as the silicone prosthesis and weighing in the cost factors does not provide convincing evidence to justify its use over the traditional silicone implant.  Admittedly, this is a short-term follow-up and future prospective long-term outcomes studies will clarify whether this new implant will benefit our patients.