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

Outcomes of proximal interphalangeal joint arthroplasty with the MatOrtho prosthesis after a minimum of 10 years

This is a prospective case review on 100 MatOrtho proximal interphalangeal joint arthroplasties in 50 patients with previously published 2-year outcomes. We report the outcomes at a minimum of 10-years' follow-up. Sixty-three implants in 29 patients were available for analysis. The visual analogue scale score for pain revealed a significant improvement of pain at 10 years (mean 0.7, SD 1.3) compared with preoperatively (mean 4.3, SD 0.8) and at 2 years (mean 1.1, SD 1.8). There was no statistically significant improvement at 10 years compared with preoperatively in the mean grip strength (10, SD 6.7), range of motion (27°, SD 20.1,), patient evaluation measure score (43, SD 22), Quick Disabilities of the Arm, Shoulder and Hand (38, SD 23) and Michigan Hand Outcome Questionnaire (65, SD 9,), but all patients remained satisfied with the surgery. Survivorship was 82% at 10 years. We conclude that this implant is suitable to use mainly for pain relief.Level of Evidence: IV.

Prosthesis Options for Proximal Interphalangeal Joint Arthroplasty in Osteoarthritis: A Systematic Review and Meta-Analysis

Background: Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). Methods: A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Results: Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Conclusions: Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level of Evidence: Level III (Therapeutic).

Reported Outcomes and Outcome Measures in Proximal Interphalangeal Joint Arthroplasty: A Systematic Review

Purpose: There is a lack of scientific consensus on the best arthroplasty implant option for proximal interphalangeal joint (PIPJ) arthritis, due to diversity in outcome reporting and measurement methods. The development of a standardized core outcome set (COS) and standard outcome measures could mitigate this issue. This study catalogs the reported outcomes and outcome measures found in PIPJ arthroplasty studies, which can be used in the first step of developing a COS. Methods: A database search of MEDLINE, EMBASE, and Web of Science (January 1, 2010, to March 10, 2021) was performed to retrieve studies that reported outcomes of the 3 most common primary PIPJ arthroplasty implants: silicone, pyrocarbon, and metal-polyethylene. The primary objectives of this study include reported outcomes and outcome measures. Secondary objectives include clinimetric properties of outcome measures, study design, and implant types. Results: Fifty articles met inclusion criteria. Of the included studies, 41 (82%) were case series, 8 (16%) were cohort studies, and 1 (2%) was a randomized control trial. Thirty-three unique outcomes were identified. Fifteen (46%) outcomes were clinician-reported and 26 (79%) were patient-reported. Eighteen unique outcome measures were identified. Of the outcome measures, 15 (83%) were patient-reported, 1 (6%) was clinician-reported, and 2 (11%) were reported by both patients and clinicians. Conclusions: Substantial heterogeneity was found in reported outcomes and outcome measures across studies evaluating PIPJ arthroplasty, impeding knowledge translation. The development of a COS for PIPJ arthroplasty is necessary to help compare and pool data across studies, and advance scientific knowledge.

Proximal interphalangeal joint prosthetic arthroplasty

Surgical treatment of the painful proximal interphalangeal (PIP) joint has evolved considerably over the past century. If arthrodesis has long been the gold standard and remains so for some, prosthesis would meet patient demand: mobility and indolence. Faced with a demanding patient, the surgeon must decide the indication, the type of prosthesis, the approach, the post-operative follow-up, etc. The history of the development of PIP prostheses demonstrates the complexity of the treatment of the destroyed PIP: appearance of prostheses, evolution and sometimes disappearance from the market for commercial reasons or related to complications. The main objective of this conference is to identify the main indications for prosthetic arthroplasties and to describe the various prostheses available on the market.

Perichondrial Arthroplasty Revisited: Technical Pearls

Articular cartilage damage has been a longstanding challenge in hand surgery. Because of its limited ability to heal on its own and its predictable impact on bone resulting in degenerative osteoarthritis, surgical intervention is often mandated, through arthrodesis or implant arthroplasty. In this article, we revisit the perichondrial arthroplasty, a two-stage joint resurfacing technique using autologous rib perichondrium. It is indicated for posttraumatic osteoarthritic changes with or without stiffness and deviation, rheumatoid arthritis, and congenital joint malformation and/or ankylosis. This long-lasting method allows for a functional, pain-free joint that avoids both the immobility of arthrodesis and the long-term complications associated with implants.

Proximal interphalangeal joint arthroplasty with the Tactys® prosthesis: Clinical and radiological outcomes at a mean 3.1 years' follow-up

Preliminary results with the Tactys® modular gliding prosthesis for proximal interphalangeal joint (PIPJ) replacement were encouraging, with notable improvement in clinical and functional scores at 1 and 2 years' follow-up. However, a recent study found a trend for deterioration over time. We wanted to check this by analyzing medium-term outcomes. Sixty-four arthroplasties were performed in 48 patients in single facility between January 2015 and January 2020. Clinical, functional, and radiographic outcomes were analyzed at short- and medium-term follow-up for 15 of these arthroplasties. Mean follow-up of the 48 patients was 3.1 years. Pain significantly decreased on the numeric rating scale (p < 0.01) and the functional QuickDASH score improved from 67.3 to 55.9 (p < 0.01). Grip and pinch strengths were lower in the operated than in the contralateral hand (p = 0.04 and p = 0.6, respectively). PIPJ active range of motion (ROM) in flexion/extension improved from 44° to 49.4° (p = 0.17). 70% of the 48 patients were satisfied. Fifteen arthroplasties were analyzed at 17 and 61 months' follow-up. Pain relief continued. ROM decreased from 57° to 46° (p < 0.05) and the functional QuickDASH score deteriorated from 25.8 to 54.7 (p < 0.01). Both grip and pinch strength increased, with a significant difference in pinch (p = 0.003). The main complication was swan-neck deformity (46%), with a mean 11 months' onset. Our results confirmed the deterioration trend observed over time in the functional results of the Tactys® prosthesis despite, good patient satisfaction. LEVEL OF EVIDENCE: 4.

Systematic review of the introduction, early phase study and evaluation of pyrocarbon proximal interphalangeal joint arthroplasty

BACKGROUND

In 2002 a pyrocarbon interphalangeal joint implant was granted Food and Drug Administration approval with limited evidence of effectiveness. It is important to understand device use and outcomes since this implant entered clinical practice in order to establish incremental evidence, appropriate study design and reporting. This systematic review summarised and appraised studies reporting pyrocarbon proximal interphalangeal joint arthroplasty.

METHODS

Systematic review of MEDLINE, EMBASE, SCOPUS, Web of Science, BIOSIS, CINAHL and CENTRAL from inception to November 2020. All study designs reporting pyrocarbon proximal interphalangeal joint arthroplasty in humans were included. Data extracted included information about study characteristics, patient selection, regulatory (gaining research ethics approval) and governance issues (reporting of conflicting interests), operator and centre experience, technique description and outcome reporting. Descriptive and narrative summaries were reported.

RESULTS

From 4316 abstracts, 210 full-text articles were screened. A total of 38 studies and 1434 (1-184) patients were included. These consisted of three case reports, 24 case series, 10 retrospective cohort studies and one randomised trial. Inclusion and exclusion criteria were stated in 25 (66%) studies. Most studies (n = 27, 71%) gained research ethics approval to be conducted. Six studies reported conflicting interests. Experience of operating surgeons was reported in nine (24%) and caseload volume in five studies. There was no consensus about the optimal surgical approach. Technical aspects of implant placement were reported frequently (n = 32) but the detail provided varied widely. Studies reported multiple, heterogenous outcomes. The most commonly reported outcome was range of motion (n = 37).

CONCLUSIONS

This systematic review identified inconsistencies in how studies describing the early use and update of an innovative procedure were reported. Incremental evidence was lacking, risking the implant being adopted without robust evaluation. This review adds to evidence highlighting the need for more rigorous evaluation of how implantable medical devices are used in practice following licencing.