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Clinical and Radiographic Outcomes of Metacarpophalangeal Pyrocarbon Arthroplasty for Osteoarthritis
Lindley B. Wall, MD; Mary S. Stern Hand Surgery Fellowship; Peter J. Stern, MD;
University of Cincinnati


Pyrocarbon non-constrained arthroplasty of the metacarpophalangeal (MCP) joints is a treatment option for those who have failed conservative management of the arthritic joint. The purpose of this study was to evaluate the effectiveness of pyrocarbon arthroplasty for the management of osteoarthritis of the MCP joint.


A retrospective review of eleven pyrocarbon arthroplasties for osteoarthritis of the MCP joint, performed by a single surgeon, was conducted. All patients returned for clinical assessment at a minimum of two years follow-up. Evaluation included range of motion, pain and function scores, and patient satisfaction. Validated outcome measures included the Michigan Hand Questionnaire and QuickDASH. Radiographs were assessed for implant failure, loosening, migration, and subsidence.


The average follow-up was 4 years (minimum 2 years). Arc of motion improved an average of 14 degrees; the average range of motion improved at final follow-up from 2 degrees to 8 degrees hyperextension and 65 degrees to 68 degrees flexion. Grip strength decreased slightly compared to the contralateral side (average 3kg). The average pain score was 1 out of 10 on a visual analogue scale. All but one patient was fully satisfied at final follow-up. All patients who were working prior to surgery, returned to work post-operatively. Michigan Hand Questionnaire average score was 80 and QuickDASH was 22. Two patients experienced asymptomatic squeaking and clicking and one patient reported extensor tendon subluxation. Only one joint underwent conversion to fusion for continued, unexplained pain. All surviving implants were noted to have surrounding lucency on radiographs. There was an average subsidence of 3mm, but no implant migration, fracture, or dislocation.


Pyrocarbon arthroplasties of the MCP joint resulted in satisfactory outcomes at average 4-year follow-up with preservation joint motion, good pain relief and satisfaction, with minimal symptomatic complications. Radiographic outcomes revealed a consistent asymptomatic surrounding lucency with no evidence of implant failure at a minimum of 2 years.

Level of Evidence: Therapeutic Level IV.

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