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The Long Term Results of PyroCarbon Implant Hemi-Arthroplasty for Trapeziometacarpal Arthritis
Jessica L. Robb, MD1; Helen Vasey, RN2; Curtis Budden, MD1; Neil F. Jones, MD2
1University of Alberta, Edmonton, AB, Canada; 2University of California - Irvine, Orange, CA

Introduction: The aim of this study is to examine the long term outcomes (> 2 years) of PyroCarbon implant hemi-arthroplasty for the treatment of osteoarthritis of the carpometacarpal joint of the thumb at a single center.
Materials and Methods: We retrospectively reviewed 20 patients who failed conservative treatment for trapezio-metacarpal arthritis and were treated with a PyroCarbon implant hemi-arthoplasty with long term followup of at least 2 years. In all cases, strong dorsal capsular reconstruction and post-operative immobilization in abduction and extension was performed to prevent implant subluxation. Patients were followed clinically and radiographically. Patient demographics, implant position on radiographs and complications were recorded. Post-operative range of motion, grip strength and key pinch were compared to the contralateral side. Subjective outcomes were assessed using a visual analog pain scale.
Results: Twelve saddle, 6 hemispheric and 2 nugrip Ascension implants were placed in 17 women and 3 men with an average age of 66 years. Average follow up was 56.9 months (range 24 95 months). All 20 patients achieved excellent range of motion, and were able to oppose their operated thumb to the base of the small finger (Kapandji score 10). Grip strength returned to 87 % and pinch strength returned to 80% compared to the contralateral hand. The subjective pain score decreased from a range of 7-10 pre-operatively to a range of 0-2 post-operatively. Serial radiographs showed no increasing lucency or significant deterioration. There were no implant dislocations or infections. No patients required surgical revision or implant removal.
Conclusion: This cohort of 20 patients with greater than 2 year follow up suggests that PyroCarbon implant hemi-arthroplasty can provide satisfactory return of strength and range of motion with minimal post-operative pain and stiffness. These clinical and radiographic outcomes were maintained for an average 4.7 years (range 2 8 years). By focusing technically on strong dorsal capsular reconstruction, there was a 0% incidence of implant subluxation or revision, which is significantly lower than previously reported.

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