To compare the outcomes of silicone proximal interphalangeal joint (PIPJ) arthroplasties to pyrolytic carbon implants in patients with osteoarthritis.
This study is a retrospective review of 41 arthroplasties in 22 patients with severe PIPJ osteoarthritis performed by a single surgeon. There were 13 patients and 22 joints in the silicone group with an average follow-up of 45 months. There were 9 patients and 19 joints in the pyrolytic carbon group with an average follow-up of 19 months. Clinical assessment included range of motion, grip strength, and deformity. Radiographs were evaluated for alignment, subsidence, and implant fracture. Patients filled out a subjective questionnaire with respect to pain, appearance of the finger, and satisfaction. Complications were recorded.
In the silicone group, the average preoperative PIPJ range of motion (ROM) was 11°/64° (extension/flexion) and the average postoperative ROM was 13°/62°. In the pyrolytic carbon group, the average preoperative PIPJ ROM was 11°/63° and the average postoperative ROM was 13°/66°. Eleven of 20 joints in the silicone group and 4 of 19 joints in the pyrolytic carbon group had a coronal plane deformity as defined by angulation of the PIPJ ≥10°. The average coronal plane deformity was 12° in the silicone group and 2° in the pyrolytic carbon group. The difference was statistically significant. In the silicone group, 3 of 22 joints required additional surgery. Two implants in one patient were removed and the PIPJ fused, and one implant was permanently removed for sepsis. In the pyrolytic carbon group, 8 of 19 joints squeaked, and there were 2 early postoperative dislocations and 2 implants with radiographic loosening. To date, there has been no revision surgery. Both groups had good pain relief. Patients were generally satisfied with the appearance of their joints in the pyrolytic carbon arm; however, satisfaction with appearance was variable in the silicone group. Nine of 13 patients in the silicone group and 6 of 7 patients in the pyrolytic carbon group would have the procedure again.
Both implants provide excellent pain relief and comparable postoperative ROM. Complications were implant specific. The results of this series show promise for the pyrolytic carbon PIPJ resurfacing arthroplasty but did not clearly demonstrate superiority compared with the silicone implant.
Type of study/level of evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Osteoarthritis of the proximal interphalangeal joint.Hand Clin. 1987; 3: 405-413
- Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion?.J Hand Surg [Am]. 1990; 15A: 194-209
- Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand.J Hand Surg [Am]. 2004; 29A: 785-795
- Swanson proximal interphalangeal joint arthroplasty in patients with rheumatoid arthritis.Clin Orthop. 1997; 342: 34-37
- Ascension Orthopaedics, Austin, TX2005: 1-6 Ascension PIPJ PryoCarbon Total Joint technique guide.
- Pyrolytic carbon proximal interphalangeal joint resurfacing arthroplasty.J Hand Surg [Am]. 2006; 31A: 930-939
- High implant fracture incidence with Sutter silicone metacarpophalangeal joint arthroplasty.J Hand Surg [Am]. 1996; 21A: 813-818
- Proximal interphalangeal joint silicone replacement arthroplasty: clinical results using an anterior approach.J Hand Surg [Am]. 1995; 20A: 123-132
- A distally based dorsal and triangular tendinous flap for direct access to the proximal interphalangeal joint.Ann Chir Main. 1988; 7: 179-189
- Ascension Orthopaedics, Austin, TX2005: 1-6 Clinical Update. Vol. 1, No. 2.
- Flexible implant arthroplasty in the proximal interphalangeal joint of the hand.J Hand Surg [Am]. 1985; 10A: 796-805
- Long-term results of proximal interphalangeal joint resection arthroplasties with a silicone implant.J Hand Surg [Am]. 1995; 20A: S95-S97
- Swanson silicone finger joint implants: a review of the literature regarding long-term complications.J Hand Surg [Am]. 1995; 20A: 445-449
- Development of a surface replacement arthroplasty for proximal interphalangeal joints.J Hand Surg [Am]. 1997; 22A: 286-298
- Early results with osseointegrated proximal interphalangeal joint prostheses.J Hand Surg [Am]. 1999; 24A: 267-274
- Radiographic evaluation of osseointegration and loosening of titanium implants in the MCP and PIP joints.J Hand Surg [Am]. 2004; 29A: 32-38
- Long-term follow-up of pyrolytic carbon metacarpophalangeal implants.J Bone Joint Surg [Am]. 1999; 81: 635-648
- On the durability of pyrolytic carbon in vivo.Med Prog Technol. 1994; 20: 201-208
- Early results of proximal interphalangeal joint replacement with pyrolytic carbon prosthesis (Ascension) in idiopathic and post-traumatic arthritis.Handchir Mikrochir Plast Chir. 2005; 37: 26-34
- Pyrocarbon prosthesis for finger interphalangeal joint replacement.Unfallchirurg. 2005; 108: 365-369
- Lateral stability of proximal interphalangeal joint replacement.J Hand Surg [Am]. 1994; 19A: 1050-1054
Accepted: April 18, 2007
Received: October 3, 2006
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
© 2007 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.