Proximal interphalangeal Joint arthroplasty

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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
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Proximal interphalangeal Joint arthroplasty

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