Pyrocarbon Metacarpophalangeal Joint Arthroplasty in Noninflammatory Arthritis: Minimum 5-Year Follow-Up.
OBJECTIVE
To report the outcomes, complications, and survivorship of pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthropathy at a minimum 5-year follow-up.


METHODS
A retrospective review of 51 implants in 36 patients was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure, Quick Disabilities of the Arm, Shoulder and Hand score, and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain.


RESULTS
There were 35 index and 16 middle fingers. The average follow-up was 103 months (range, 60-172 months). The mean arc of motion was 54° (range, 20° to 80°). There was no difference in grip strength between operated and nonsurgical side. Six implants were revised, and 3 of these required additional surgery. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 27 (range, 10-54) and 29 (range, 0-57), respectively. Mean visual analog scores for pain, satisfaction, and appearance were all 1 with the respective ranges being 0-7, 0-4, and 0-6. Most implants were Herren grade 1 lucency with the remaining 5 proximal and 12 distal implants being grade 2. Mean subsidence in the proximal component was 2 mm (range, 0-4 mm) and 1 mm (range, 0-3 mm) in the distal component. The degree of loosening or subsidence did not correlate with outcome. Implant survival as assessed by Kaplan-Meier was 88% at 10 years.


CONCLUSIONS
Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. All implant revisions were performed within 18 months of the index procedure. This may represent technical issues rather than problems with the implant.
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom. Electronic address: davidrdickson@hotmail.com.
David R
DR
Dickson
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
Ravi
R
Badge
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
David
D
Nuttall
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
Adam C
AC
Watts
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
Sumedh C
SC
Talwalkar
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
Mike
M
Hayton
Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom.
Ian A
IA
Trail
D000328:Adult; D000368:Aged; D050806:Arthroplasty, Replacement, Finger / Q000009:adverse effects / Q000379:methods*; D002244:Carbon; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D007595:Joint Prosthesis; D053208:Kaplan-Meier Estimate; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000473:pathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
C009139:pyrolytic carbon; D002244:Carbon
Pyrocarbon; arthroplasty; metacarpophalangeal joint; outcome; survivorship