Thomas M Sweets1, Peter J Stern. 1. Department of Orthopedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0212, USA.
Abstract
BACKGROUND: Pyrolytic carbon resurfacing arthroplasty of the proximal interphalangeal joint has been reported to provide favorable results. The purpose of this study was to evaluate the effectiveness of pyrolytic carbon joint replacement at an average follow-up of fifty-five months. METHODS: A retrospective review of thirty-one arthroplasties of the proximal interphalangeal joint performed by a single surgeon in seventeen patients with interphalangeal joint osteoarthritis was conducted. Assessment included range of motion, patient satisfaction, and pain scores. Radiographs were evaluated for alignment, implant subsidence, and implant failure. The Michigan Hand Outcomes Questionnaire was administered at the time of the final follow-up. RESULTS: The average follow-up period was fifty-five months (minimum, two years). No patient was lost to follow-up. The arc of motion of the interphalangeal joint decreased from 57° preoperatively to 31° (p < 0.05) at the time of the final follow-up. The average score for pain was 3 of 10 on a visual analog scale. Satisfaction averaged 3.4 points on a 5-point Likert scale, and twelve of seventeen patients stated that they would repeat the surgery. Data from the Michigan Hand Outcomes Questionnaire were compared for the involved and noninvolved hands of the fifteen patients who received implants unilaterally. Significant deficits were observed in the total outcome score, activities of daily living, function, and satisfaction for the operatively treated hand. Pain was also greater in the operatively treated hand. Complications included implant fracture (one joint), dislocation (five joints), squeaking (eleven), loosening (fifteen), and interphalangeal joint contracture (twenty). Six joints required a reoperation (an arthrodesis in four joints, a silicone arthroplasty in one, and excision of exostosis in one). Implant migration was severe for seven proximal phalanx implants and three distal phalanx implants, and one implant breached the phalangeal cortex. CONCLUSIONS: Interphalangeal joint motion decreased significantly at the final follow-up evaluation, following short-term gains in the initial postoperative period. Complications were numerous, and implant loosening with migration was a major problem. Arthroplasty of the proximal interphalangeal joint with a pyrolytic carbon implant has a high complication rate, poor outcomes, and variable patient satisfaction. On the basis of these findings, we no longer use this implant in our practice.
BACKGROUND: Pyrolytic carbon resurfacing arthroplasty of the proximal interphalangeal joint has been reported to provide favorable results. The purpose of this study was to evaluate the effectiveness of pyrolytic carbon joint replacement at an average follow-up of fifty-five months. METHODS: A retrospective review of thirty-one arthroplasties of the proximal interphalangeal joint performed by a single surgeon in seventeen patients with interphalangeal joint osteoarthritis was conducted. Assessment included range of motion, patient satisfaction, and pain scores. Radiographs were evaluated for alignment, implant subsidence, and implant failure. The Michigan Hand Outcomes Questionnaire was administered at the time of the final follow-up. RESULTS: The average follow-up period was fifty-five months (minimum, two years). No patient was lost to follow-up. The arc of motion of the interphalangeal joint decreased from 57° preoperatively to 31° (p < 0.05) at the time of the final follow-up. The average score for pain was 3 of 10 on a visual analog scale. Satisfaction averaged 3.4 points on a 5-point Likert scale, and twelve of seventeen patients stated that they would repeat the surgery. Data from the Michigan Hand Outcomes Questionnaire were compared for the involved and noninvolved hands of the fifteen patients who received implants unilaterally. Significant deficits were observed in the total outcome score, activities of daily living, function, and satisfaction for the operatively treated hand. Pain was also greater in the operatively treated hand. Complications included implant fracture (one joint), dislocation (five joints), squeaking (eleven), loosening (fifteen), and interphalangeal joint contracture (twenty). Six joints required a reoperation (an arthrodesis in four joints, a silicone arthroplasty in one, and excision of exostosis in one). Implant migration was severe for seven proximal phalanx implants and three distal phalanx implants, and one implant breached the phalangeal cortex. CONCLUSIONS: Interphalangeal joint motion decreased significantly at the final follow-up evaluation, following short-term gains in the initial postoperative period. Complications were numerous, and implant loosening with migration was a major problem. Arthroplasty of the proximal interphalangeal joint with a pyrolytic carbon implant has a high complication rate, poor outcomes, and variable patient satisfaction. On the basis of these findings, we no longer use this implant in our practice.