title: Outcomes of pyrolytic carbon arthroplasty for the proximal interphalangeal joint at 44 months' mean follow-up.
abstract: BACKGROUND
  Short-term results after proximal interphalangeal joint arthroplasty with pyrolytic carbon (pyrocarbon) implant have shown that this implant has high complication rates, but patient satisfaction is high. The authors evaluated the effectiveness of the implant for use in proximal interphalangeal joint at a minimum of 2 years of follow-up.
  
  
  METHODS
  Thirteen consecutive candidates who underwent 21 proximal interphalangeal joint arthroplasty procedures with pyrocarbon implant were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire were administered preoperatively and at 12 months and intermediate term (>2 years) postoperatively. Preoperative and intermediate-term mean data for all functional measures and questionnaire scores were compared.
  
  
  RESULTS
  Thirteen patients were treated, with a mean follow-up of 44 months. Grip strength, key pinch strength, and active arc of motion demonstrated no statistical difference between preoperative and intermediate-term assessment. All domains of the Michigan Hand Outcomes Questionnaire showed improved large effect size at intermediate-term follow-up, especially pain and satisfaction. There were 10 complications in nine joints (complication rate, 42.9 percent). Patients without complications had better functional outcomes; however, there were no statistical differences in questionnaire scores between patients with and without complications, except for pain (p = 0.04).
  
  
  CONCLUSIONS
  Proximal interphalangeal joint arthroplasty with pyrocarbon implant seems to be an effective way of reducing pain without sacrificing active arc of motion. Despite a high complication rate, patients were generally satisfied, especially with pain relief, and complications did not affect patients' satisfaction even when hand function was affected. Further decision-making analysis to compare arthroplasty and fusion for each finger may help surgeons to select the appropriate operative procedures.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Department of Neurosurgery, The University of Michigan Health System.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Ono
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.forename: Kate W C
authors.initials: KWC
authors.lastname: Chang
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000368:Aged; D050806:Arthroplasty, Replacement, Finger; D001672:Biocompatible Materials; D002244:Carbon; D005260:Female; D005384:Finger Joint / Q000601:surgery*; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C009139:pyrolytic carbon; D002244:Carbon