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Fig. 1 A, Immediate postoperative radiograph of PIP joint shows good alignment in the sagittal plane. B, Radiograph at final follow-up shows wide radiolucent lines, subsidence, and dislocation with erosion of the distal implant into the head of the proximal phalanx.
Courtesy of Peter J. Stern, MD

AAOS Now

Published 12/1/2010

Poor results with pyrocarbon implants

Pyrolytic carbon arthroplasty (PCA) has a high incidence of complications, poor outcomes, and variable patient satisfaction at long-term follow-up, according to Thomas M. Sweets, MD, and should not be recommended for treatment of osteoarthritis of the proximal interphalangeal (PIP) joint.

The results of a retrospective review conducted by Dr. Sweets and fellow researcher, Peter J. Stern, MD, found that patients who had received PCA of the PIP joint had decreased range of motion (ROM), lower functional scores, and increased pain in the operated hand compared to the contralateral hand after an average 55-month follow-up. The 17 patients in the study had a diagnosis of primary osteoarthritis, and all surgeries were performed by a single surgeon prior to October 2007.

The average age at surgery was 64 years, and 30 of the 31 joints belonged to women. Implants had been placed in 7 index fingers, 14 long fingers, 8 ring fingers, and 2 small fingers. All patients had preoperative coronal angulation less than 20 degrees, adequate bone stock, and intact collateral ligaments.

Results
At final follow-up, average ROM had decreased from a postoperative best of 65 degrees to 28 degrees (p < .0001). The 15 patients who had received implants in one hand reported more pain and lower scores in function, overall activities of daily living, and satisfaction in the surgical hand when compared to the nonoperated hand.

Complications included 11 squeaky joints, 20 contracted joints, 3 dislocations, and 1 instance of hardware fractures. Six joints in 6 patients required reoperation. Implant migration was severe in 7 proximal phalanx and 3 middle phalanx implants, and 1 implant breached the phalangeal cortex (Fig. 1). Radiographic evidence of loosening was present in 16 joints.

“Based on these findings,” concluded the researchers, “we no longer recommend this implant for the treatment of osteoarthritis of the PIP joint.”

Disclosure information: Dr. Sweets—no conflicts; Dr. Stern— Trustee for Journal of Bone and Joint Surgery–American.

Bottom line

  • This retrospective review found an unacceptably high incidence of complications and poor outcomes among patients treated with pyrolytic carbon arthroplasty for PIP joint arthritis.
  • Implant migration created serious deformity in several patients.
  • Patients rated the hand treated with surgery as significantly more painful than the untreated hand.