gms | German Medical Science

Objectives/Interrogation: Pyrocarbon total arthroplasty is an established treatment option for arthritis of the proximal interphalangeal joint (PIPJ). We hypothesized that despite the varied results published in literature, pyrocarbon for total PIPJ arthroplasty can produce reliable and effective outcomes.

Methods: 101 total PIPJ arthroplasties have been performed in 75 patients since 2002. Prior to surgery, 14 patients completed baseline questionnaires and 52 had their range of motion measured. These were compared to 44 joints assessed at 5 years or later after surgery. 31 joints were assessed between 5 - 9 years and 19 joints at equal or greater than 10 years (6 joints were seen at both time points). Assessments included QuickDASH and PRWHE questionnaires and measures of range of motion, grip and pinch strength. Non-parametric Wilcoxon rank sum test for independent samples was used for analysis.

Results and Conclusions: Visual Analogue Scale pain decreased from a median of 68 at pre-operative assessment to 1 at equal or greater than 10 years (p=0.0001), while satisfaction increased from 7 to 98 at the same intervals (p=0.03). QuickDASH and PRWHE scores improved from 46.6 and 71 respectively at pre-op assessment to 29.5 and 18.5 at equal or greater than 10 years after the surgery (QuickDASH not significant, PRWHE p=0.002). Global Rating of Change showed a median of +6 for symptoms and +5 for function. Range of motion increased from baseline to 5 - 9 years (flexion 70° compared to 50° before surgery, p=0.004). There is a slight reduction in flexion and an improvement in extension (decrease in fixed flexion) at 10 years (flexion 60° compared to 50° before surgery, not significant). Grip strength was maintained after arthroplasty (not significant). Eight joints are known to have undergone revision surgery: 5 revisions to other arthroplasty (4 silicone, 1 pyrocarbon total due to secondary trauma), 2 revised to joint fusion (one a result of secondary trauma at 7 years post index surgery), and one with details unknown. An additional six have undergone secondary surgery without revision for tenolysis/release.

This is a large case series with 19 patients followed up for 10 years or longer. Results compare favourably with published series in clinical and functional outcome measures. Joint revision rate is low and reoperation rates comparable to other studies. Pyrocarbon for total PIP joint arthroplasty can produce reliable and effective outcomes.