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Outcome of Pyrocarbon Arthroplasty of Proximal Interphalangeal Joint
Nash Naam, MD; Patrick Stewart, MD; Danielle Westendorf, MOTR/L; Lonni Weis, OTR/L, CHT; Lori Niemerg, OTR/L, CHT
Southern Illinois Hand Center and Southern Illinois University, Effingham, IL

Hypothesis: Pyrocarbon arthroplasty of the Proximal Interphalangeal ( PIP) joints has been used for treatment of advanced osteoarthritis and posttraumatic arthritis.  Recently there have been reports of unfavorable outcome of this procedure. The purpose of our study is to report our experience of using Pyrocarbon arthroplasty for PIP degenerative and posttraumatic arthritis.  Objective and subjective outcome measures were used for the evaluation.

Material and Methods: From 2003 to 2009 9 joints in 8 patients were treated with Pyrocarbon arthroplasty.  The 6 female and 2 male patients averaged 63 years (range 52 -78).  Diagnosis was degenerative arthritis in 7 and posttraumatic arthritis in 2 patients. Four patients were retired and 4 were still working.   Post operative follow up averaged 49 months (range 14 - 94) . Pain visual analogue scale (VAS), range of motion (ROM), and   grip and pinch strength were evaluated.  Subjective outcome was measured using DASH score. Radiographic evaluation was conducted for stability of the prosthesis and any radiolucency around the stem

Results: Four patients underwent additional surgery.  Two had revisions; one for tightness of the joint and one had dislocation and the prosthesis fell during open reduction.  One patient had tenolysis and  superficialis tenodesis and one had check rein ligament release.  Pain (VAS) at rest averaged 0.27 and 1.7 with activity.  Range of motion averaged -12° extension and 67° flexion. Statistically significant improvement in AROM was noted in the 2 posttruamatic arthritis patients.   Grip, lateral and palmar pinch strength averaged 107%,  110% and 115% of the contralateral side respectively.  DASH score averaged 8 at rest and 9 with work activities. The employed patients went back to their original work activities.  Radiographs demonstrated stability of the prosthesis.  One patient had minimal collapse of the proximal phalanx.  No abnormal radiolucency was observed.  Patient satisfaction averaged 4.4 on a scale of 1 to 5 with the 5 being fully satisfied. All patients stated that they would do the surgery again and recommend this surgery to others.

Conclusion: All patients reported marked improvement of pain.  Grip and pinch strength improved.  AROM also improved in the posttraumatic arthritis patients.  Despite of the 2 revisions and the 2 other additional surgeries, patients were uniformly satisfied with the procedure and they indicated they would do it again.  With careful selection PIP Pyrocarbon  arthroplasty can be a reliable procedure to improve pain and functional use of the hand with high patient satisfaction .   


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