Purpose
To compare the outcomes of silicone proximal interphalangeal joint (PIPJ) arthroplasties
to pyrolytic carbon implants in patients with osteoarthritis.
Methods
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.
Results
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.
Conclusions
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
Therapeutic III.
Key words
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Article info
Publication history
Accepted:
April 18,
2007
Received:
October 3,
2006
Footnotes
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.
Identification
Copyright
© 2007 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
