Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties

Eric R. Wagner, John T. Weston, Matthew T. Houdek, T. David Luo, Steven Lawrence Moran, Marco Rizzo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant. Methods: The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed. Results: At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion. Conclusions: Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish (US)
Pages (from-to)797-805
Number of pages9
JournalJournal of Hand Surgery
Volume43
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Reoperation
Arthroplasty
Joints
Arthritis
Pain
Intraoperative Complications
Kaplan-Meier Estimate
Survival Analysis
Postoperative Pain
Osteoarthritis
pyrolytic carbon
Logistic Models
Survival

Keywords

  • arthroplasty
  • PIP
  • Proximal interphalangeal joint
  • pyrocarbon

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty : A Study of 170 Consecutive Arthroplasties. / Wagner, Eric R.; Weston, John T.; Houdek, Matthew T.; Luo, T. David; Moran, Steven Lawrence; Rizzo, Marco.

In: Journal of Hand Surgery, Vol. 43, No. 9, 01.09.2018, p. 797-805.

Research output: Contribution to journalArticle

Wagner, Eric R. ; Weston, John T. ; Houdek, Matthew T. ; Luo, T. David ; Moran, Steven Lawrence ; Rizzo, Marco. / Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty : A Study of 170 Consecutive Arthroplasties. In: Journal of Hand Surgery. 2018 ; Vol. 43, No. 9. pp. 797-805.
@article{20624d94b89a42c4818197f9e7a149dc,
title = "Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties",
abstract = "Purpose: The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant. Methods: The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed. Results: At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34{\%}) were required, including 36 (21{\%}) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79{\%} and 77{\%}, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28{\%} with grade 3+ loosening and 36{\%} with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion. Conclusions: Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained. Type of study/level of evidence: Therapeutic IV.",
keywords = "arthroplasty, PIP, Proximal interphalangeal joint, pyrocarbon",
author = "Wagner, {Eric R.} and Weston, {John T.} and Houdek, {Matthew T.} and Luo, {T. David} and Moran, {Steven Lawrence} and Marco Rizzo",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.jhsa.2018.06.020",
language = "English (US)",
volume = "43",
pages = "797--805",
journal = "Journal of Hand Surgery",
issn = "0266-7681",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty

T2 - A Study of 170 Consecutive Arthroplasties

AU - Wagner, Eric R.

AU - Weston, John T.

AU - Houdek, Matthew T.

AU - Luo, T. David

AU - Moran, Steven Lawrence

AU - Rizzo, Marco

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Purpose: The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant. Methods: The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed. Results: At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion. Conclusions: Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained. Type of study/level of evidence: Therapeutic IV.

AB - Purpose: The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant. Methods: The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed. Results: At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion. Conclusions: Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained. Type of study/level of evidence: Therapeutic IV.

KW - arthroplasty

KW - PIP

KW - Proximal interphalangeal joint

KW - pyrocarbon

UR - http://www.scopus.com/inward/record.url?scp=85051752855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051752855&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2018.06.020

DO - 10.1016/j.jhsa.2018.06.020

M3 - Article

C2 - 30172276

AN - SCOPUS:85051752855

VL - 43

SP - 797

EP - 805

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0266-7681

IS - 9

ER -