Skip to main content

Advertisement

SpringerLink
Log in

Outcome of proximal interphalangeal joint replacement with pyrocarbon implants: a long-term longitudinal follow-up study

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to compare the short-, mid-, and long-term results of pyrocarbon PIPJ arthroplasty.

Materials and methods

Twenty-seven consecutive patients (9 males, 18 females) had arthroplasty for 32 pyrocarbon PIPJ prostheses. Two patients (two joints) were lost for follow-up. Four implants were removed during follow-up. Fifteen patients (18 implants) were available for a long-term follow-up assessment on average 9.7 (9–10.8) years postoperatively and seven patients with eight implants had telephone interviews to calculate the implant survival and complications. Of the 15 patients who came to the latest follow-up, 12 (14 implants) passed each of the three follow-up visits for short-term (ø 19 months), mid-term (ø 54 months), and long-term follow-up (ø 9.8 years) to compare functional and radiological parameters longitudinally.

Results

In total, seven of the 30 joints (23%) required a revision surgery, all within the first 2 years postoperatively, including three arthrodesis due to early infection or dislocation, and one distal component removal due to primary loosening. Three patients required soft tissue revisions. The implant survival after 9 years was 87%.

There was minimal pain at rest throughout the 9-year follow-up analysis; pain with activity was rated 1.9 at the short-term assessment, 1.5 at mid-term, and 1.6 at long-term. The average active range of motion was at short-, mid-, and long-term examination 49°, 50°, and 48° and grip strength averaged 24, 24, and 21 kg, respectively. The DASH score was stable with 35, 36, and 33 points. At the long-term follow-up, all evaluated implants showed radiological signs of implant loosening or migration. According to the PIP joint outcome score, 57% resulted finally in a “good” outcome.

Conclusions

Pyrocarbon PIPJ arthroplasty has a risk of early complications necessitating revision surgeries. In spite of radiological implant migration, good pain relief, grip strength, and high quality-of-life ratings are stable for a long time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Leibovic SJ, Bowers WH (1994) Anatomy of the proximal interphalangeal joint. Hand Clin 10(2):169–178

    CAS  PubMed  Google Scholar 

  2. Jacobs BJ, Verbruggen G, Kaufmann RA (2010) Proximal interphalangeal joint arthritis. J Hand Surg Am 35(12):2107–2116. https://doi.org/10.1016/j.jhsa.2010.09.002

    Article  PubMed  Google Scholar 

  3. Murray PM (2006) Prosthetic replacement of the proximal interphalangeal joint. Hand Clin 22(2):201–206. https://doi.org/10.1016/j.hcl.2006.02.005

    Article  PubMed  Google Scholar 

  4. Zhu AF, Rahgozar P, Chung KC (2018) Advances in proximal interphalangeal joint arthroplasty: biomechanics and biomaterials. Hand Clin 34(2):185–194. https://doi.org/10.1016/j.hcl.2017.12.008

    Article  PubMed  PubMed Central  Google Scholar 

  5. Branam BR, Tuttle HG, Stern PJ, Levin L (2007) Resurfacing arthroplasty versus silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg Am 32(6):775–788. https://doi.org/10.1016/j.jhsa.2007.04.006

    Article  PubMed  Google Scholar 

  6. Forster N, Schindele S, Audige L, Marks M (2018) Complications, reoperations and revisions after proximal interphalangeal joint arthroplasty: a systematic review and meta-analysis. J Hand Surg Eur 43(10):1066–1075. https://doi.org/10.1177/1753193418770606

    Article  Google Scholar 

  7. Daecke W, Kaszap B, Martini AK, Hagena FW, Rieck B, Jung M (1779e) A prospective, randomized comparison of 3 types of proximal interphalangeal joint arthroplasty. J Hand Surg Am 37(9):1770–1779e1771 1773. https://doi.org/10.1016/j.jhsa.2012.06.006

    Article  CAS  PubMed  Google Scholar 

  8. McGuire DT, White CD, Carter SL, Solomons MW (2012) Pyrocarbon proximal interphalangeal joint arthroplasty: outcomes of a cohort study. J Hand Surg Eur 37(6):490–496. https://doi.org/10.1177/1753193411434053

    Article  CAS  Google Scholar 

  9. Bravo CJ, Rizzo M, Hormel KB, Beckenbaugh RD (2007) Pyrolytic carbon proximal interphalangeal joint arthroplasty: results with minimum two-year follow-up evaluation. J Hand Surg Am 32(1):1–11. https://doi.org/10.1016/j.jhsa.2006.10.017

    Article  PubMed  Google Scholar 

  10. Wijk U, Wollmark M, Kopylov P, Tagil M (2010) Outcomes of proximal interphalangeal joint pyrocarbon implants. J Hand Surg Am 35(1):38–43. https://doi.org/10.1016/j.jhsa.2009.08.010

    Article  PubMed  Google Scholar 

  11. Sweets TM, Stern PJ (2011) Pyrolytic carbon resurfacing arthroplasty for osteoarthritis of the proximal interphalangeal joint of the finger. J Bone Joint Surg Am 93(15):1417–1425. https://doi.org/10.2106/JBJS.J.00832

    Article  PubMed  Google Scholar 

  12. Mora AN, Earp BE, Blazar PE (2020) Midterm Clinical and Radiographic Follow-Up of Pyrolytic Carbon PIP Arthroplasty. J Hand Surg Am 45 (3):253 e251–253 e256. https://doi.org/10.1016/j.jhsa.2019.06.008

  13. Wagner ER, Weston JT, Houdek MT, Luo TD, Moran SL, Rizzo M (2018) Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties. J Hand Surg Am 43(9):797–805. https://doi.org/10.1016/j.jhsa.2018.06.020

    Article  PubMed  Google Scholar 

  14. Schulz M, Muller-Zimmermann A, Behrend M, Krimmer H (2005) Early results of proximal interphalangeal joint replacement with pyrolytic carbon prosthesis (Ascension) in idiopathic and post-traumatic arthritis. Handchir Mikrochir Plast Chir 37(1):26–34. https://doi.org/10.1055/s-2005-837533

    Article  CAS  PubMed  Google Scholar 

  15. Tägil M, Geijer M, Abramo A, Kopylov P (2014) Ten years experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up. J Hand Surg Eur Vol 39 (6):587–595 https://doi.org/10.1177/1753193413479527

  16. Hutt JR, Gilleard O, Hacker A, Citron N (2012) Medium-term outcomes of pyrocarbon arthroplasty of the proximal interphalangeal joint. J Hand Surg Eur 37(6):497–500. https://doi.org/10.1177/17531934124376301753193412437630[pii]

    Article  CAS  Google Scholar 

  17. Watts AC, Hearnden AJ, Trail IA, Hayton MJ, Nuttall D, Stanley JK (2012) Pyrocarbon proximal interphalangeal joint arthroplasty: minimum two-year follow-up. J Hand Surg Am 37(5):882–888. https://doi.org/10.1016/j.jhsa.2012.02.012

    Article  CAS  PubMed  Google Scholar 

  18. Storey PA, Goddard M, Clegg C, Birks ME, Bostock SH (2015) Pyrocarbon proximal interphalangeal joint arthroplasty: a medium to long term follow-up of a single surgeon series. J Hand Surg Eur 40(9):952–956. https://doi.org/10.1177/1753193414566552

    Article  CAS  Google Scholar 

  19. Heers G, Telisselis P, Winkler F, Grifka J, Borisch N (2012) Mid-term outcome after implantation of a pyrocarbon endoprosthesis in patients with degenerative arthritis. Z Orthop Unfall 150(3):324–328. https://doi.org/10.1055/s-0031-1298389

    Article  CAS  PubMed  Google Scholar 

  20. Dickson DR, Nuttall D, Watts AC, Talwalkar SC, Hayton M, Trail IA (2015) Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Five-Year Follow-Up. J Hand Surg Am 40 (11):2142–2148 e2144. https://doi.org/10.1016/j.jhsa.2015.08.009

  21. Reissner L, Schindele S, Hensler S, Marks M, Herren DB (2014) Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement. J Hand Surg Eur 39(6):582–586. https://doi.org/10.1177/1753193413511922

    Article  CAS  Google Scholar 

  22. Chamay A (1988) A distally based dorsal and triangular tendinous flap for direct access to the proximal interphalangeal joint. Ann Chir Main 7(2):179–183

    Article  CAS  Google Scholar 

  23. Meier R, Schulz M, Krimmer H, Stutz N, Lanz U (2007) Proximal interphalangeal joint replacement with pyrolytic carbon prostheses. Oper Orthop Traumatol 19(1):1–15. https://doi.org/10.1007/s00064-007-1192-8

    Article  PubMed  Google Scholar 

  24. Germann G, Harth A, Wind G, Demir E (2003) Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire. Unfallchirurg 106 (1):13–19. https://doi.org/10.1007/s00113-002-0456-x

  25. Chung KC, Pillsbury MS, Walters MR, Hayward RA (1998) Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 23(4):575–587. https://doi.org/10.1016/S0363-5023(98)80042-7

    Article  CAS  PubMed  Google Scholar 

  26. Macey AC, Burke FD, Abbott K, Barton NJ, Bradbury E, Bradley A, Bradley MJ, Brady O, Burt A, Brown P (1995) Outcomes of hand surgery. British Society for Surgery of the Hand. J Hand Surg Br 20(6):841–855

    Article  CAS  Google Scholar 

  27. Dias JJ, Bhowal B, Wildin CJ, Thompson JR (2001) Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias? J Bone Joint Surg Br 83(2):235–240

    Article  CAS  Google Scholar 

  28. Herren DB, Schindele S, Goldhahn J, Simmen BR (2006) Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results. J Hand Surg Br 31(6):643–651. https://doi.org/10.1016/j.jhsb.2006.08.004

    Article  CAS  PubMed  Google Scholar 

  29. Vogt R, Aerni M, Ampofo C, Schmelzer-Schmied N (2012) Proximal interphalangeal (PIP) finger prosthesis - what have we learnt? Experiences over 10 years. Handchir Mikrochir Plast Chir 44(5):293–299. https://doi.org/10.1055/s-0032-1323841

    Article  CAS  PubMed  Google Scholar 

  30. Ono S, Shauver MJ, Chang KW, Chung KC (2012) Outcomes of pyrolytic carbon arthroplasty for the proximal interphalangeal joint at 44 months' mean follow-up. Plast Reconstr Surg 129(5):1139–1150. https://doi.org/10.1097/PRS.0b013e31824a2e38

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Harald Selig, the primary investigator of this study, died by a snowslide accident before this paper was finished. The corresponding author, who assisted Harald with the data analysis, finished  his work posthum. This paper is dedicated to Harald Selig as our former resident in hand surgery in Bad Neustadt, a promising researcher, and a wonderful collegue and friend. Thanks to Bernd Kolbe MD, Clinic for Foot and Ankle Surgery, Rhön Medical Center, Campus Bad Neustadt for sharing his scientific work to support Harald Selig.

Funding

There was no external funding of the study.

Author information

Authors and Affiliations

  1. Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany

    Harald F. Selig, Thomas Pillukat, Karl Josef Prommersberger, Jörg van Schoonhoven & Marion Mühldorfer-Fodor

  2. Clinic for Plastic and Hand Surgery, HELIOS Klinikum Emil Von Behring GmbH, Berlin, Germany

    Matthias Schulz

Authors
  1. Harald F. Selig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Pillukat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl Josef Prommersberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörg van Schoonhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marion Mühldorfer-Fodor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marion Mühldorfer-Fodor.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of the Rhön Medical Center.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Selig, H.F., Schulz, M., Pillukat, T. et al. Outcome of proximal interphalangeal joint replacement with pyrocarbon implants: a long-term longitudinal follow-up study. Arch Orthop Trauma Surg 140, 1847–1857 (2020). https://doi.org/10.1007/s00402-020-03592-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03592-3

Keywords

Search

Navigation