Proximal interphalangeal Joint arthroplasty

Ascension PyroCarbon PIP
summary of clinical Results
INTERNAL USE ONLY NMP-CSM-PIP rev 09/2010

Overview of PyroCarbon PIP Clinical Results
Overview of PyroCarbon PIP
Clinical Results
PYC PIP
Table of Contents
Summary .....................................................................................................1
Review of PyroCarbon PIP Clinical Results
Long-Term Evaluation of Pyrolytic Carbon Implant Arthroplasty in the Proximal Interphalangeal Joint of the Hand (Abstract) ....... 2
Outcomes of Proximal Interphalangeal Joint PyroCarbon Implants.......................................................3
Outcomes of Pyrolytic Carbon Arthroplasty for the Proximal Interphalangeal Joint ..........................................4
Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty: Results with Minimum Two-Year Follow-Up Evaluation.............5
Resurfacing Arthroplasty versus Silicone Arthroplasty for Proximal Interphalangeal Joint Osteoarthritis .........................6
Proximal Interphalangeal Joint Replacement with Pyrolytic Carbon Prostheses .............................................7
Pyrolytic Carbon Proximal Interphalangeal Joint Resurfacing Arthroplasty.................................................8
Pyrolytic Carbon Arthroplasty for Posttraumatic Arthritis of the Proximal Interphalangeal Joint................................9
Problematic Bone Fixation with Pyrocarbon Implants in Proximal Interphalangeal Joint Replacement: Short-Term Results......... 10
Case Reports
Intraoperative Fracture of a Pyrocarbon PIP Total Joint – A Case Report ............................................... 11
Creation of Four-Joint-Digit after Second Toe to Digit Transplantation: Restoration of Form and Function.. . . . . . . . . . . . . . . . . . . 11
Surgical Techniques and Postoperative Therapy
Postoperative Management for PIP Joint Pyrocarbon Arthroplasty ................................................. 12
The Volar Approach to Proximal Interphalangeal Joint Arthroplasty. ............................................... 12
New Joint Replacements of the Hand and Wrist................................................................ 12
PIP and MCP Joint Arthroplasty ........................................................................... 13
Proximal Interphalangeal Joint Arthroplasty................................................................... 13
Competitive Studies
Cemented Versus Uncemented Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint with a
Mean 5-Year Follow-Up................................................................................ 14
Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using the PIP-SRA Implant: Results,
Complications, and Revisions............................................................................ 15
Development of a Surface Replacement Arthroplasty for Proximal Interphalangeal Joints ............................... 16
Bibliography ................................................................................................ 17
INTERNAL USE ONLY
INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
Summary
Title of Report Citation Eval. Group Follow-Up Evaluation Result According to Authors
Long-term Evaluation of the Pyrolytic
Carbon Implant Arthroplasty in the
Proximal Interphalangeal Joint of the
Hand (Abstract)
Outcomes of Proximal Interphalangeal
Joint PyroCarbon Implants
Hsu et al.,
2010
Wijk et al,
2010
164 joints,
107 patients
53 joints,
43 patients
Mean
23.6 months
Minimum
1 year, mean
23 months
ROM, pain,
grip strength
Pain, ROM,
grip strength,
DASH, COPM
ROM increased, grip strength
increased, pain relief was present
in 84.1% of patients who received
implant
Decreased pain in all patients,
increase in ROM, improved grip
strength, DASH score and COPM
PYC PIP
Outcomes of Pyrolytic Carbon
Arthroplasty for the Proximal
Interphalangeal Joint
Chung et al.,
2009
21 joints,
14 patients
Taken
preoperatively,
3, 6, and
12 months
postoperatively
Arc of motion, grip
and pinch strength,
Michigan hand score
Improvement of grip and pinch
strength, excellent pain relief, high
patient satisfaction
Pyrolytic Carbon Proximal
Interphalangeal Joint Arthroplasty:
Results with Minimum Two-Year
Follow-Up Evaluation
Bravo et al.,
2007
50 joints,
35 patients
Mean
27 months
Arc of motion, grip and
pinch strength, pain
Increased arc of motion, improved
grip and pinch strength, pain scores
improved from 6 to 1 (scale, 0-10)
postoperatively
Resurfacing Arthroplasty versus
Silicone Arthroplasty for Proximal
Interphalangeal Joint Osteoarthritis
Brenam et al.,
2007
41 joints,
22 patients
Silicone group:
45 months,
Pyrocarbon
group:
19 months
ROM, grip strength,
patient satisfaction,
appearance
Silicone group had decreased ROM,
1kg increase in grip strength, 6.2 out
of 10 satisfaction score. PyroCarbon
group has increased ROM, 5kg
increase in grip strength, 8.1 out of
10 satisfaction score
Proximal Interphalangeal Joint
Replacement with Pyrolytic Carbon
Prostheses
Meier et al.,
2007
24 joints,
20 patients
Mean
15 months
ROM, pain
Average ROM was 50°, significant
pain relief in all cases
Pyrolytic Carbon Proximal
Interphalangeal Joint Resurfacing
Arthroplasty
Tuttle et al.,
2006
18 joints,
8 patients
Mean
13.7 months
ROM, grip strength,
pain, satisfaction score
Increased grip strength, average
pain score of 1.8 (scale, 1-10), good
patient satisfaction
Pyrolytic Carbon Arthroplasty for
Posttraumatic Arthritis of the Proximal
Interphalangeal Joint
Nunley et al.,
2006
7 joints,
5 patients
Mean
17 months
Grip strength,
DASH scores, pain
Grip strength increased from 19kg to
26 kg after surgery, increased DASH
scores, decrease in pain
Problematic Bone Fixation with
PyroCarbon Implants in Proximal
Interphalangeal Joint Replacement:
Short-Term Results
Herren et al.,
2006
17 joints,
14 patients
Mean
19 months
ROM, grip strength,
pain
High patient satisfaction, increased
ROM and grip strength, significant
pain relief for patients
Competitive Studies
Cemented Versus Uncemented Surface
Replacement Arthroplasty for the
Proximal Interphalangeal Joint with a
Mean 5-Year Follow-Up
Johnstone et al.,
2008
48 Avanta
SR PIP joints,
32 patients
Mean
5 years
Arc of motion,
pain, joint failures,
radiological loosening
Decreased pain score in both groups,
2 joint failures in cemented group, 5
joint failures in uncemented group,
uncemented group had 13 joints with
radiological loosening
Surface Replacement Arthroplasty for
the Proximal Interphalangeal Joint
Using the PIP-SRA Implant: Results,
Complications and Revisions
Jennings et al.,
2008
43 Sbi PIP-SRA
joints,
25 patients
Mean
37 months
Arc of motion,
patient satisfaction,
complications
DIP motion decreased 12°
postoperatively, 12% of patients
were not satisfied with implant, 26%
revision rate
Development of a Surface
Replacement Arthroplasty for Proximal
Interphalangeal Joints
Linscheid et al.,
1997
66 CrCo and
polyethylene
joints,
47 patients
Mean
4.5 years
ROM, pain,
complications,
secondary operations
ROM increased from 35° to 47°
after surgery, a significant number
of complications occurred, 12
secondary operations were performed
in 11 fingers
INTERNAL USE ONLY
1

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Long-Term Evaluation of Pyrolytic Carbon Implant Arthroplasty
in the Proximal Interphalangeal Joint of the Hand
Abstract presented at aahs 2010, boca raton, florida
Chun-Cheng Hsu, Steven Moran, Marco Rizzo, MD, Robert D. Beckenbaugh, MD
PYC PIP
Purpose
The purpose of the study was to retrospectively review long-term outcomes of pyrolytic carbon implant arthroplasty of the
proximal interphalangeal joint (PIPJ), especially evaluating functional results and complications.
Demographics
• 164 implants in 107 patients
• Indications:
o 54 – osteoarthritis
o 19 – rheumatoid arthritis
o 29 – posttraumatic arthritis
o 5 – psoriatic arthritis
“The pyrolytic carbon implant
for PIPJ arthroplasty is effective
in providing pain relief and
better grip power.”
Follow Up
Patients were observed for an average of 23.6 months.
Results
• ROM improved after surgery going from an average of 34.4° preoperatively to 50.4° one year after surgery
• The mean grip power improved from 15.5 Kg preoperatively to 17 Kg one year after surgery
• Pain relief was present in 84.1% of patients who received a PIPJ implant
CONCLUSION
The pyrolytic carbon implant for PIPJ arthroplasty is effective is providing pain relief and better grip power. The
active ROM improvement could be encouraged after surgery. However, the potential of gradual active ROM downhill
after 1 year follow up should be concerned.
TABLE 1 Preoperative 3 month 6 month 1 year 2 year 3 year 4 year 5 year 6 year
Number of f/u fingers 167 143 128 95 69 52 24 12 5
Active ROM (°) 34.4 49.0 49.8 50.4 40.4 35.5 42.3 43.9 59.8
Extensor Lag (°) 16.0 23.6 24.4 20.8 21.9 17.1 18.8 12.4 2.6
Compared with
previous f/u (°)
Compared with active
ROM of 3-month f/u (°)
— 14.9 1.4 -2.3 -8.8 -4.2 -2.8 -9.0 8.2
— — 1.4 0.7 -9.7 -14.8 -9.1 -9.8 0.2
Hsu CC, Moran S, Rizzo M, Beckenbaugh R. Long-Term Evaluation of Pyrolytic Carbon Implant Arthroplasty in the Proximal Interphalangeal Joint of the Hand.
Abstract presented at AAHS 2010, Boca Raton, Florida
2
INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Outcomes of Proximal Interphalangeal Joint PyroCarbon Implants
Journal of Hand surgery, January 2010, Vol. 35a
Ulrika Wijk, BS, Margareta Wollmark, BS, Philippe Kopylov, Md, PhD, Magnus Tagil, PhD
Purpose
To prospectively register and report the hand function and occupational performance of patients with proximal interphalangeal
joint-pyrocarbon arthroplasty, using both objective tests and subjective outcome instruments.
Demographics
• 53 joints in 43 patients
• Average age of patient: 59 years old. Range: 40-85 years old
• Indications:
o 28 – Degenerative Osteoarthritis
o 7 – Post Traumatic
o 8 – Rheumatoid Arthritis
“All subjective scores such as
the VAS (pain) at rest and activity,
COPM, and DASH score
improved significantly.”
PYC PIP
Follow Up
Patients were observed for a minimum of 1 year (aevrage 23 months)
Results
• Pain decreased in all patients
• Average patient flexion motion increased from 100° to 138° post operatively
o Average ROM decreased from 15°-100° to 0°-138°
o Each patient was given a slight flexion contracture to avoid hyperextension, which accounts for decrease in hyperextension
• Average grip strength improved from 19Kg to 21kg,
• DASH score improved from a median of 39 to 29
• COPM (patient reported functional outcome measure) improved from 3.8 to 5.9 after surgery
• 13% revision rate
o 7 joints in 7 patients required re-operation: three patients had prosthesis removed due to pain, one patient had
a tenolysis for limited ROM, one RA patient had a postoperative infection with skin necrosis, one patient had a
tenoarthrolysis due to stiffness and extension lag, one patient was re-operated on due to increasing hyperextension
and secondary swan-neck deformity
CONCLUSION
All patients reported decreased pain, and although the authors found no improvement in range of motion and
grip strength, one third of patients reported a clinically significant improvement in occupational performance and
satisfaction. A total of 13% of the joints required a secondary surgical procedure.
Wijk U, Wollmark M, Kopylov P, Tagil M. Outcomes of Proximal Interphalangeal Joint Pyrocarbon Implants. J Hand Surg 2010; 35A: 38-43
INTERNAL USE ONLY
3

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Outcomes of Pyrolytic Carbon Arthroplasty for the
Proximal Interphalangeal Joint
plastic and reconstructive surgery, May 2009, volume 123, number 5
Kevin Chung, MD, Ashwin Ram, B.S., Melissa Shauver, M.P.H.
PYC PIP
Purpose
The specific aim of this study was to assess outcomes and complication rates of a consecutive series
of patients undergoing proximal interphalangeal joint arthroplasty using the pyrocarbon implant.
Demographics
• 21 joints in 14 patients
• Average age of patient: 54 years old. Range: 34-72 years old.
• Indications:
o 10 – Osteoarthritis
o 3 – Posttraumatic
o 1 – Psoriatic Arthritis
Follow Up
“The PyroCarbon implant for the
proximal interphalangeal joint
arthroplasty shows encouraging
results, primarily in patient
satisfaction and pain relief.”
Patient follow-up taken preoperatively, 3, 6, and 12 months
postoperatively
Results
• Arc of motion fluctuated during follow-up period
• Improvement of grip strength from an average of 11.3 kg to 15.1 kg
after surgery
• Statistically significant improvement in key pinch strength from 6.6 kg
preoperatively to 9.2 kg at the 12 month follow-up
• Michigan Hand Score revealed a large improvement in all domains
(scale 0-100)
o Excellent pain relief: from 66 to 22 postoperatively
o High satisfaction: from 32 to 61 postoperatively
o Large improvements in aesthetics: from 34 to 70 postoperatively
Radiograph of the left hand showing
placement of a PyroCarbon implant in the
left middle PIP joint and removal of silicone
implant and fusion of the left index PIP joint.
(Plast. Reconstr. Surg. 2009; 123 : 1527)
CONCLUSION
The PyroCarbon implant for proximal interphalangeal joint arthroplasty shows encouraging results, primarily
in patient satisfaction and pain relief, but is associated with complications related to implant dislocations, which
required prolonged treatment with external fixators.
Chung KC, Ram AN, Shauver MJ. Outcomes of Pyrolytic Carbon Arthroplasty for the Proximal Interphalangeal Joint. Plat. Reconstr Surg 2009; 123:1521-1532
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INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty:
Results with Minimum Two-Year Follow-Up Evaluation
journal of hand surgery (Am.) 2007; 32A:1-11
Cesar J. Bravo, MD, Marco Rizzo, MD, Kirsten B. Hormel, RN, Robert D. Beckenbaugh, MD
Purpose
The purpose of this study is to retrospectively review the surgical technique, postoperative therapy/splinting protocols, and
clinical and radiographic outcomes of patients who had pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty.
Demographics
• 50 joints in 35 patients
• Average age of patient: 53 years old
Range: 21-73 years old
• Indications:
o 14 – Osteoarthritis
o 11 – Rheumatoid arthritis
o 10 – Posttraumatic arthritis
“With these early results, the
investigators concluded that pyrolytic
PIP arthroplasty is superior to
arthrodesis in the management of
PIP joint arthritis.”
PYC PIP
Follow Up
• Average follow-up period of 27 months
Results
• Average arc of motion increased from 40° preoperatively to 47° postoperatively
• Grip strength improved to 25 kg (13% increase)
• Pinch strength improved to 4 kg (23% increase)
• All patients had pain relief after the procedure. Pain scores improved from 6 to 1 (scale, 0-10) postoperatively
CONCLUSION
The authors’ two year minimum follow-up evaluation of pyrolytic carbon implant arthroplasty showed improved
pain relief and good overall patient satisfaction. Twenty-eight percent of patients required a second procedure and
8% required a revision arthroplasty. Radiographs showed gross changes in implant and eventual settling to a stable
position in 40% of the joints. A longer follow-up period will help to better determine the efficacy of this implant.
Bravo CJ, Rizzo M, Hormel K, Beckenbaugh RD. Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty: Results with Minimum Two-Year Follow-Up Evaluation.
J Hand Surg (Am.) 2007; 32A:1-11
INTERNAL USE ONLY
5

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Resurfacing Arthroplasty versus Silicone Arthroplasty
for Proximal Interphalangeal Joint Osteoarthritis
journal of hand surgery (Am.) 2007; 33:775-788
Branam BR, Tuttle HG, Ster PG, Levin L
PYC PIP
Purpose
The purpose of this study is to compare the outcomes of silicone proximal interphalangeal joint (PIPJ) arthroplasties to pyrolytic
carbon implants in patients with osteoarthritis.
Demographics
• 41 arthroplasties in 22 patients
o Silicone: 13 patients and 33 joints.
o PyroCarbon: 9 patients and 19 joints.
• Average age 62 years old
• Indications: All patients had severe osteoarthritis and
had failed nonoperative treatment
Follow Up
• Silicone group: average follow up of 45 months
• PyroCarbon group: average follow up of 19 months
“Major problem with silicone,
their inability to correct or resist
progressive joint deformity.
Implant fracture or failure occurred
moderately frequently in
the silicone group.”
Results
• ROM
o Silicone group exhibited a 4° decrease in ROM
o PyroCarbon group exhibited a 1° increase in ROM
• Grip Strength
o Silicone pre-op 18Kg post op 19Kg (1Kg increase)
o PyroCarbon pre-op 9Kg post op 14Kg (5Kg increase)
• Average satisfaction score (out of 10)
o Silicone 6.2
o PyroCarbon 8.1
• Complications
o Silicone had 3 major complications
o No major complications in the pyrolytic carbon group
• Appearance
o 8 silicone patients believe appearance of their joint
was worse postoperatively
o 16 PyroCarbon patients noted improved appearance
of their joint postoperatively
Radiograph of the patient who had pipj pyrolytic carbon
arthroplasty of the index finger and silicone arthroplasties
of the middle and small fingers. Anterposterior radiograph
at 4.5 months postoperatively showing marked radial
deviation of the middle finger pipj.
J Hand Surg 2007; 32A:781
CONCLUSION
Both implants provide excellent pain relief and comparable postoperative range of motion. Complications were
implant specific. The results of this series show promise for the pyrolytic carbon PIPJ resurfacing arthroplasty but
did not clearly demonstrate superiority compared with the silicone implant.
Branam BR, Tuttle HG, Ster PG, Levin L. Resurfacing Arthroplasty versus Silicone Arthroplasty for Proximal Interphalangeal Joint Osteoarthritis. J Hand Surg 2007; 32A: 775-788
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INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Proximal Interphalangeal Joint Replacement
with Pyrolytic Carbon Prostheses
oper orthop traumatol 2007; 19:1-15
Meier R, Schulz M, Krimmer H, Stutz N, Lanz U
Purpose
Replacement of the PIP joint using an unconstrained pyrolytic carbon prosthesis for pain reduction while generally preserving
mobility and stability.
Demographics
• 24 implants in 20 patients
• Average age of patient: 61 years old.
Range: 35-80 years old
• Indications:
o 14 – Idiopathic arthritis
o 5 – Posttraumatic arthritis
o 1 – Polyarthritis
“The choice of pyrolytic carbon as
the implant material made the
components almost friction-free,
durable, and biocompatible.”
PYC PIP
Follow Up
• Average follow-up period of 15 months
Results
• Average range of motion was 50°
• Significant pain relief in all cases
• 16 out of 20 patients said they were satisfied with the result and would undergo the same operation again
CONCLUSION
An unconstrained pyrolytic carbon prosthesis in the proximal interphalangeal joint significantly reduces pain while
maintaining mobility for the patient.
Meier R, Schulz M, Krimmer H, Stutz N, Lanz U. Proximal Interphalangeal Joint Replacement with Pyrolytic Carbon Prostheses. Oper Orthop Traumatol 2007; 19: 1-15
INTERNAL USE ONLY
7

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Pyrolytic Carbon Proximal Interphalangeal Joint Resurfacing Arthroplasty
J Hand Surg. (am.) 2006;31A: 930-939
Harrison G. Tuttle, MD, Peter J. Stern, MD
PYC PIP
Purpose
The purpose of this study is to evaluate the clinical results of a pyrolytic carbon resurfacing proximal interphalangeal joint
(PIPJ) arthroplasty in patients with osteoarthritis.
Demographics
• 18 implants in 8 women
• Average age of patient: 62 years old. Range: 52-71 years old
• Indications: Advanced osteoarthritis with debilitating pain
in the PIPJ that was resistant to non-surgical treatment
Follow Up
• Average follow up of 13.7 months
“This implant has the
potential to achieve all of the
requirements of successful
PIPJ arthroplasty.”
Results
• Range of motion had great variability after surgery
o Pre op 10°/60° (Ext/flex)
o Post opt 18°/71° (Ext/flex)
• Grip strength increased from 10.2 kg preoperatively
to 12.8 kg postoperatively
• Average pain score was 1.8 (scale 0-10), 8 joints were pain-free
• Average satisfaction score was 8.4 (scale 0-10)
• Seventeen out of the 18 arthroplasties had coronal plane deformity
after surgery; the authors now liberally use fluoroscopy when broaching
the medullary canals to minimize the possibility of implant angulation.
PIPJ implant dislocation follow-up
radiograph at 6 months after surgery. There
is a near-complete correction of the
preoperative ulnar deviation.
CONCLUSION
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.
Tuttle HG, Stern PJ. Pyrolytic Carbon Proximal Interphalangeal Joint Resurfacing Arthroplasty. J Hand Surg 2006; 31A: 930-939
8
INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Pyrolytic Carbon Arthroplasty for the Posttraumatic Arthritis
of the Proximal Interphalangeal Joint
J Hand surg (am.) 2006; 1468-1472
Ryan M. Nunley, MD, Martin I. Boyer, MD, Charles A Goldfarb, MD
Purpose
The purpose of this study is to prospectively evaluate the subjective and objective functional outcome of patients treated with a
pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty for posttraumatic arthritis.
Demographics
• 7 joints in 5 patients
• Average age of patient: 40 years old.
Range: 28-56 years old
• Inclusion criteria were patients with radiographic evidence of
advanced posttraumatic arthritis, persistent pain, loss of motion
and functional limitations
Follow Up
• Average follow up of 17 months (range: 12-23 months)
“Pyrolytic carbon has an elastic
modulus similar to bone with
an assumed higher durability
and wear resistance, making it
potentially a better option for
younger active patients.”
PYC PIP
Results
• Grip strength increased from 19kg preoperatively
to 26kg postoperatively
• DASH scores increased from 32 before surgery to 35 after surgery
• Decrease in pain
CONCLUSION
In this series, the authors prospectively evaluated the objective and functional outcomes after pyrolytic carbon PIP
arthroplasty performed for posttraumatic arthritis. Subjectively, patients were not improved after the surgery; all
patients had pain although the pain scores were slightly improved. Objective data showed a high complication rate
without improvement of PIP joint motion. The authors believe these results relate to the poor quality of bone and
soft tissues after PIP joint trauma; we were unable to achieve a satisfactory outcome with the pyrocarbon implant in
these difficult patients. For this reason, we no longer perform this surgery in posttraumatic patients.
Nunley RM, Boyer MI, Goldfarb CA. Pyrolytic Carbon Arthroplasty for Posttraumatic Arthritis of the Proximal Interphalangeal Joint. J Hand Surg (Am.) 2006; 31A: 1468-1474
INTERNAL USE ONLY
9

Overview of PyroCarbon PIP Clinical Results
CLINICAL report
Problematic Bone Fixation with PyroCarbon Implants in
Proximal Interphalangeal Joint Replacement: Short-Term Results
J Hand surg (am.) 2006; 31:643-651
Herren DB, Schindele, S, Goldhahn, J, Simmen BR
PYC PIP
Purpose
The purpose of this study was to review a consecutive series of pyrocarbon PIP joint implants with particular focus on implant
anchorage radiologically and the functional status of the replaced joints clinically.
Demographics
• 17 joints in 14 patients
• Average age of patient: 64 years old. Range: 55-81 years old
• Indications:
o 15 – Degenerative osteoarthritis
o 1 – Chondrocalcinosis
o 1 – Posttraumatic osteoarthritis
“Prosthetic replacement of
a destroyed PIP joint may
improve function and give
good pain relief.”
Follow Up
• Average follow up of 19 months
Results
• Range of motion increased from 34° preoperatively to 42° postoperatively
• Grip strength improved from 20.3kp to 26kp postoperatively
• Significant pain relief for patients, going from 7.6 to 1.3 postoperatively (1-10 scale)
• Overall high patient satisfaction
CONCLUSION
Patients who had stable implants were associated with better results with respect to pain relief and range of motion
than devices with migration, although the results were not statistically significant. It seems that the unstable implants,
after a phase of migration, settled in a new, more stable position again. This may explain the relatively small effect on
clinical results, despite the significant radiological changes.
Herren DB, Schindele S, Goldhahn J, Simmen BR. Problematic Bone Fixation with PyroCarbon Implants in Proximal Interphalangeal Joint Replacement: Short-Term Results.
J Hand Surg (Br.) 2006; 31: 643-651
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Overview of PyroCarbon PIP Clinical Results
CASE reportS
Intraoperative Fracture of a PyroCarbon PIP Total Joint – A Case Report
hand 2007; 2:90-93
Martin Skie, Nicholas Gove, Despina Ciocanel
This case report is about a 33 year old man with posttraumatic arthritis of the proximal interphalangeal joint right long finger.
The case was treated surgically using the Ascension PyroCarbon PIP total joint. During a proximal interphalangeal joint
arthroplasty, the doctors noticed a crack at the neck of the proximal implant. While the articular portion of the implant was
easily removed, the removal of the stem required making a 2-3mm burr hole at the proximal end of the stem so that the doctors
could use a retractor to push the stem out far enough to retrieve it. Another implant was then inserted without complications.
This was the first reported case of a PIP joint implant which was broken during insertion, and the doctors believe the implant
fracture occurred because of insufficient volar bone resection at the proximal phalanx.
PYC PIP
Skie M, Gove N, Ciocanel D. Intraoperative Fracture of a Pyrocarbon PIP Total Joint: A Case Study. Hand 2007; 2:90-93
Creation of Four-Joint-Digit after Second Toe-to-Digit Transplantation:
Restoration of Form and Function
microsurgery 2008; 28:628-631
Darrell Brooks, MD, Rudolf F. Buntic, MD, Ramon de Jesus, MD
The authors describe the non-orthotopic insertion of an
Ascension two-piece pyrocarbon proximal interphalangeal joint
at the osteosynthesis level of bilateral toe-to-digit transplantations
in an attempt to restore both anatomic length and composite fist
formation after traumatic multidigit loss. Creation of two four
joint fingers by the addition of non-orthotopic joints in toe-todigit
reconstructions successfully restored form and function
after multidigit loss.
Brooks D, Buntic RF, de Jesus, R. Creation of Four-Joint-Digit after Second Toe to Digit
Transplantation: Restoration of Form and Function. Microsurgery 2008; 28:628-631
(a) Bilateral second toe-to-digit transplantation restores function
after traumatic multi-digit amputation; (b) the discrepancy in
toe-to-digit length is highlighted when there are neighboring
digits for comparison. (Microsurgery 2008; 28: 629)
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11

Overview of PyroCarbon PIP Clinical Results
TECHNIQUES & POSTOP
Postoperative Management for PIP Joint PyroCarbon Arthroplasty
journal of hand therapy 2010; “in press”
Fledscher S.
PYC PIP
This article discusses the modification of
a postoperative treatment protocol for a
patient who received a pyrocarbon PIP
joint arthroplasty.
Fledscher S. Postoperative Management for PIP Joint
Pyrocarbon Arthroplasty. Journal of Hand Therapy 2010;
“In Press”
(A) This hand-based dorsal block splint was found on X-ray (B) to properly align pyrocarbon implant
Journal of Hand Therapy 2010, “In Press”
The Volar Approach to Proximal Interphalangeal Joint Arthroplasty
Technique in hand & upper extremity surgery 2009; 13:47-53
Scott F. M. Duncan, MD, MPH, Marianne V. Merritt, RN, RNFA, Ryosuke Kakinoki, MD, PhD
This article discusses the technique and possible complications when using a volar approach for a PIP joint arthroplasty. The
authors believe a volar approach has many advantages over using a dorsal approach for a PIP joint arthroplasty, as supported in
a study they conducted which is pending publication. Their results were as good or better than the published results for PIP
arthroplasty through a dorsal approach.
Duncan SFM, Merrit MV, Kakinoki R. The Volar Approach to Proximal Interphalangeal Joint Arthroplasty. Technique in Hand & Upper Extremity Surgery 2009; 13:47-53
New Joint Replacements of the Hand and Wrist
Technique in hand & upper extremity Hand surgery quarterly, winter 2008
Brian Adams, M.D., Robert Beckenbaugh, M.D., Peter Murray, M.D., Kevin J. Renfree, M.D., Paul Brach, PT, MS, CHT
This discussion focuses around the different types of joint replacements that each doctor uses and their recommendations and
reservations for this area of medicine.
Adams B, Beckenbaugh R, Murray P, Renfree KJ, Brach P. New Joint Replacements of the Hand and Wrist. Hand Surgery Quarterly, Winter 2008
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Overview of PyroCarbon PIP Clinical Results
TECHNIQUES & POSTOP
PIP and MCP Joint Arthroplasty
Brisbane hand and upper limb clinic
Mark Ross
Contains description of:
• Pyrocarbon
• Volar approach
• Dorsal approach
• Rehabilitation
• Outcomes
o Total joint PIP
o Hemiarthroplasty PIP and MCP
PYC PIP
Ross M. AHSS Sept 2008 ICL-11 PIP and MCP Joint Arthroplasty. Brisbane Hand and Upper Limb Clinic
Proximal Interphalangeal Joint Arthroplasty
j am acad orthop surg. 2007; 15: 189-196
Marco Rizzo, MD, Robert D Beckenbaugh, MD
This article contains information about the differences between silicone and pyrolytic carbon implants for the proximal
interphalangeal joint, indications and contraindications, surgical technique and a postoperative splinting protocol. Also included
is a review of published studies that favored the pyrolytic carbon implant, saying that it “has the ability to improve pain, achieve
stability, and provide satisfactory ROM.
Rizzo M, Beckenbaugh RD. Proximal Interphalangeal Joint Arthroplasty. J Am Acad Orthop Surg 2007; 15:189-196
INTERNAL USE ONLY
13

Overview of PyroCarbon PIP Clinical Results
competitive studies
Cemented Versus Uncemented Surface Replacement Arthroplasty of the
Proximal Interphalangeal Joint With a Mean 5-Year Follow-Up
j hand surg 2008; 33a:726-732
Johnstone BR, Fitzgerald M, Smith KR, Currie LJ
PYC PIP
Purpose
To retrospectively compare the long-term results of SBi cemented and uncemented surface replacement arthroplasties of the proximal
interphalangeal (PIP) joint in a single surgeon’s experience.
Demographics
• 48 Avanta SR PIP joints in 32 patients
o 27 cemented joints in 18 patients
o 18 uncemented joints in 18 patients
• Average age of patient
o Cemented group: 53 years old
o Uncemented group: 56 years old
• Indications:
o 22 – Osteoarthritis
o 6 – Seronegative arthritis
o 4 – Rheumatoid arthritis
o 11 – Posttraumatic problems
“Our study has shown significant
problems with loosening
uncemented implants (p

Overview of PyroCarbon PIP Clinical Results
competitive studies
Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint
Using the PIP-SRA Implant: Results, Complications, and Revisions
j hand surg 2008; 33a:1565-1572
Charles D. Jennings, MD, Douglas P. Livingstone, BS
Purpose
To evaluate the subjective and objective results of surface replacement arthroplasty (SRA) for arthritis of the proximal interphalangeal (PIP)
joint using the PIP-SRA implant. Emphasis is placed on causes of complications, failures, and techniques used for revision.
Demographics
• 43 arthroplasties in 25 patients
• Average age of patient: 62 years old. Range: 20-80 years old
• Indications:
o 39 – Osteoarthritis
o 2 – Posttraumatic arthritis
o 2 – Rheumatoid arthritis
PYC PIP
Follow Up
• Average follow-up time: 37 months
Results
• Arc of motion
o PIP motion increased 1° postoperatively (from 57° to 58°)
o DIP motion decreased 12° postoperatively (from 36° to 24°)
• Patient satisfaction rating
o 60% Very satisfied
o 28% Fairly satisfied
o 12% Not satisfied
• Complications:
o Stress shielding in 15 components
o Peri prosthetic radiolucency in 9 components
o Loosening in 16 components
o 26% revision rate (11 out of 43)
o 4% of cemented prosthesis loosened (2 out of 45)
o 39% of uncemented prosthesis loosened (16 out of 41)
B) Patient 15, right index
finger, showing loosening,
with migration of proximal
component. (C) Patient 9, right
long finger, showing stress
shielding (most extreme case).
J Hand Surg 2008; 33A: 1565
CONCLUSION
Surface replacement arthroplasty of the PIP joint holds promise for the future. It offers motion and stability for the index
finger unattainable with silicone arthroplasty. These results do not differ notable from those of other series using this
implant, except that failures due to loosening in this study were almost exclusively associated with the lack of cement.
Therefore, the authors recommend using cement with the PIP-SRA implant in every case until superior long-term
results can be demonstrated using uncemented components. Proximal Interphalangeal joint arthroplasty is an exacting
procedure no matter what technique or implant is used, and no on technique has yet been proven superior to all others.
Jennings CD, Livingston DP. Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using the PIP-SRA Implant: Results, Complications, and Revisions. J Hand
Surg 2008; 33A: 1565-1572
INTERNAL USE ONLY
15

Overview of PyroCarbon PIP Clinical Results
competitive studies
Development of a Surface Replacement Arthroplasty
for Proximal Interphalangeal Joints
J Hand surg (am.) 1997; 22A: 286-298
Linscheid R, Murray P, Vidal MA, Beckenbaugh R
PYC PIP
This article is about replacing the surface of a proximal interphalangeal prostheses with a CrCo proximal and an ultrahighmolecular-weight
polyethylene distal component.
Demographics
• 66 joints in 47 patients
• Average age of patient: 58 years old. Range: 18-92 years old
• Indications:
o 24 – Osteoarthritis
o 15 – Traumatic arthrosis
o 8 – Rheumatoid arthritis or a variant
Follow Up
• Average follow up of 4.5 years
“The number of complications in
this series was significant.”
Results
• Range of motion increased from 35° to 47° after surgery
• Postoperative pain:
o 56 joints were pain free
o 6 joints had mild aching
o 4 joints had moderate discomfort with activity
• A significant number of complications occurred, including but not limited to:
o Instability (5 joints)
o Postural deformity (5 joints)
o Stiffness in extension (7 joints had less than 15° of active motion)
• 12 secondary operations were performed in 11 fingers
CONCLUSION
Although the results reported here are varied, it is worth noting that the severity of the problems was sometimes
marked and that the indications for arthroplasty in many cases could be considered salvage procedures. Even in some
patients with limited movement, pain relief was dramatic.
Linscheid R, Murray P, Vidal MA, Beckenbaugh R. Development of a Surface Replacement Arthroplasty for Proximal Interphalangeal Joints. J Hand Surg 1997; 22A:286-298
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INTERNAL USE ONLY

Overview of PyroCarbon PIP Clinical Results
PyroCarbon PIP Bibliography
Hsu CC, Moran S, Rizzo M, Beckenbaugh R. Long-Term Evaluation of Pyrolytic Carbon Implant Arthroplasty in the
Proximal Interphalangeal Joint of the Hand. Abstract presented at AAHS 1020 Boca Raton, Florida
Wijk U, Wollmark M, Kopylov P, Tagil M. Outcomes of Proximal Interphalangeal Joint Pyrocarbon Implants. J Hand Surg
2010; 35A: 38-43
Chung KC, Ram AN, Shauver MJ. Outcomes of Pyrolytic Carbon Arthroplasty for the Proximal Interphalangeal Joint. Plat.
Reconstr Surg 2009; 123:1521-1532
Bravo CJ, Rizzo M, Hormel K, Beckenbaugh RD. Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty: Results with
Minimum Two-Year Follow-Up Evaluation. J Hand Surg (Am.) 2007; 32A:1-11
PYC PIP
Branam BR, Tuttle HG, Ster PG, Levin L. Resurfacing Arthroplasty versus Silicone Arthroplasty for Proximal Interphalangeal
Joint Osteoarthritis. J Hand Surg 2007; 32A: 775-788
Meier R, Schulz M, Krimmer H, Stutz N, Lanz U. Proximal Interphalangeal Joint Replacement with Pyrolytic Carbon
Prostheses. Oper Orthop Traumatol 2007; 19: 1-15
Tuttle HG, Stern PJ. Pyrolytic Carbon Proximal Interphalangeal Joint Resurfacing Arthroplasty. J Hand Surg 2006; 31A: 930-939
Nunley RM, Boyer MI, Goldfarb CA. Pyrolytic Carbon Arthroplasty for Posttraumatic Arthritis of the Proximal
Interphalangeal Joint. J Hand Surg (Am.) 2006; 31A: 1468-1474
Herren DB, Schindele S, Goldhahn J, Simmen BR. Problematic Bone Fixation with PyroCarbon Implants in Proximal
Interphalangeal Joint Replacement: Short-Term Results. J Hand Surg (Br.) 2006; 31: 643-651
Skie M, Gove N, Ciocanel D. Intraoperative Fracture of a Pyrocarbon PIP Total Joint: A Case Study. Hand 2007; 2:90-93
Brooks D, Buntic RF, de Jesus, R. Creation of Four-Joint-Digit after Second Toe to Digit Transplantation: Restoration of Form
and Function. Microsurgery 2008; 28:628-631
Fledscher S. Postoperative Management for PIP Joint Pyrocarbon Arthroplasty. Journal of Hand Therapy 2010; “In Press”
Duncan SFM, Merrit MV, Kakinoki R. The Volar Approach to Proximal Interphalangeal Joint Arthroplasty. Technique in Hand
& Upper Extremity Surgery 2009; 13:47-53
Adams B, Beckenbaugh R, Murray P, Renfree KJ, Brach P. New Joint Replacements of the Hand and Wrist. Hand Surgery
Quarterly, Winter 2008
Ross M. AHSS Sept 2008 ICL-11 PIP and MCP Joint Arthroplasty. Brisbane Hand and Upper Limb Clinic
Rizzo M, Beckenbaugh RD. Proximal Interphalangeal Joint Arthroplasty. J Am Acad Orthop Surg 2007; 15:189-196
Johnstone BR, Fitzgerald M, Smith KR, Currie LJ. Cemented Versus Uncemented Surface Replacement Arthroplasty of the
Proximal Interphalangeal Joint With a Mean 5-Year Follow-Up. J Hand Surg 2008; 33A: 726-732
Jennings CD, Livingston DP. Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using the PIP-SRA
Implant: Results, Complications, and Revisions. J Hand Surg 2008; 33A: 1565-1572
Linscheid R, Murray P, Vidal MA, Beckenbaugh R. Development of a Surface Replacement Arthroplasty for Proximal
Interphalangeal Joints. J Hand Surg 1997; 22A:286-298
INTERNAL USE ONLY
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