Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties
The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant. The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. D...
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| Veröffentlicht in: | The Journal of hand surgery (American ed.) 2018-09, Vol.43 (9), p.797-805 |
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| creator | Wagner, Eric R. Weston, John T. Houdek, Matthew T. Luo, T. David Moran, Steven L. Rizzo, Marco |
| description | The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant.
The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed.
At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion.
Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained.
Therapeutic IV. |
| doi_str_mv | 10.1016/j.jhsa.2018.06.020 |
| format | Article |
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The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed.
At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion.
Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained.
Therapeutic IV.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2018.06.020</identifier><identifier>PMID: 30172276</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; Arthritis - surgery ; arthroplasty ; Arthroplasty, Replacement, Finger ; Carbon ; Female ; Finger Joint - diagnostic imaging ; Finger Joint - surgery ; Follow-Up Studies ; Hand Strength ; Humans ; Intraoperative Complications ; Joint Prosthesis ; Male ; Middle Aged ; PIP ; Postoperative Complications ; Proximal interphalangeal joint ; pyrocarbon ; Radiography ; Range of Motion, Articular ; Reoperation - statistics & numerical data ; Retrospective Studies ; Risk Factors ; Young Adult</subject><ispartof>The Journal of hand surgery (American ed.), 2018-09, Vol.43 (9), p.797-805</ispartof><rights>2018 American Society for Surgery of the Hand</rights><rights>Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-a7f9378b8c90f34af207e0a87695f7c1801a7da31da07d72d7008fc83279fca83</citedby><cites>FETCH-LOGICAL-c400t-a7f9378b8c90f34af207e0a87695f7c1801a7da31da07d72d7008fc83279fca83</cites><orcidid>0000-0001-9363-2768 ; 0000-0003-0390-1018 ; 0000-0001-8466-5154</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhsa.2018.06.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30172276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wagner, Eric R.</creatorcontrib><creatorcontrib>Weston, John T.</creatorcontrib><creatorcontrib>Houdek, Matthew T.</creatorcontrib><creatorcontrib>Luo, T. David</creatorcontrib><creatorcontrib>Moran, Steven L.</creatorcontrib><creatorcontrib>Rizzo, Marco</creatorcontrib><title>Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant.
The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed.
At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion.
Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained.
Therapeutic IV.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthritis - surgery</subject><subject>arthroplasty</subject><subject>Arthroplasty, Replacement, Finger</subject><subject>Carbon</subject><subject>Female</subject><subject>Finger Joint - diagnostic imaging</subject><subject>Finger Joint - surgery</subject><subject>Follow-Up Studies</subject><subject>Hand Strength</subject><subject>Humans</subject><subject>Intraoperative Complications</subject><subject>Joint Prosthesis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>PIP</subject><subject>Postoperative Complications</subject><subject>Proximal interphalangeal joint</subject><subject>pyrocarbon</subject><subject>Radiography</subject><subject>Range of Motion, Articular</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Young Adult</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFu2zAURIkgReKmvUAWgZbZSP0kLVEKujGMtA2QIgGaokuCpj5jGpLoklRQ3cZn8clKw2nRVVezeTPAPEIuKRQUaPVhU2zWQRUMaF1AVQCDEzKjJad5VVbzUzIDXvG8BMbPydsQNgCpxcszcs6BCsZENSPTV2zt2OdP6PvsYYza9RiyHzaus8fJO638yg3Zo3e_bK-6_e5uiOi3a9Wp4RlVly18XHu37VSI0022yL7FsZ32O2f2Oypgv1u6IaAeo33Bf1mL4R15Y1QX8P1rXpDvn26fll_y-4fPd8vFfa7nADFXwjRc1KtaN2D4XBkGAkHVompKIzStgSrRKk5bBaIVrBUAtdE1Z6IxWtX8glwfd7fe_RwxRNnboLFLD9CNQTJoGphTRpuEsiOqvQvBo5Fbn277SVKQB-VyIw_K5UG5hEom5al09bo_rnps_1b-OE7AxyOA6eWLRS-DtjjoJN6jjrJ19n_7vwHFvJcF</recordid><startdate>201809</startdate><enddate>201809</enddate><creator>Wagner, Eric R.</creator><creator>Weston, John T.</creator><creator>Houdek, Matthew T.</creator><creator>Luo, T. David</creator><creator>Moran, Steven L.</creator><creator>Rizzo, Marco</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9363-2768</orcidid><orcidid>https://orcid.org/0000-0003-0390-1018</orcidid><orcidid>https://orcid.org/0000-0001-8466-5154</orcidid></search><sort><creationdate>201809</creationdate><title>Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties</title><author>Wagner, Eric R. ; Weston, John T. ; Houdek, Matthew T. ; Luo, T. David ; Moran, Steven L. ; Rizzo, Marco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-a7f9378b8c90f34af207e0a87695f7c1801a7da31da07d72d7008fc83279fca83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthritis - surgery</topic><topic>arthroplasty</topic><topic>Arthroplasty, Replacement, Finger</topic><topic>Carbon</topic><topic>Female</topic><topic>Finger Joint - diagnostic imaging</topic><topic>Finger Joint - surgery</topic><topic>Follow-Up Studies</topic><topic>Hand Strength</topic><topic>Humans</topic><topic>Intraoperative Complications</topic><topic>Joint Prosthesis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>PIP</topic><topic>Postoperative Complications</topic><topic>Proximal interphalangeal joint</topic><topic>pyrocarbon</topic><topic>Radiography</topic><topic>Range of Motion, Articular</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wagner, Eric R.</creatorcontrib><creatorcontrib>Weston, John T.</creatorcontrib><creatorcontrib>Houdek, Matthew T.</creatorcontrib><creatorcontrib>Luo, T. David</creatorcontrib><creatorcontrib>Moran, Steven L.</creatorcontrib><creatorcontrib>Rizzo, Marco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hand surgery (American ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wagner, Eric R.</au><au>Weston, John T.</au><au>Houdek, Matthew T.</au><au>Luo, T. David</au><au>Moran, Steven L.</au><au>Rizzo, Marco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties</atitle><jtitle>The Journal of hand surgery (American ed.)</jtitle><addtitle>J Hand Surg Am</addtitle><date>2018-09</date><risdate>2018</risdate><volume>43</volume><issue>9</issue><spage>797</spage><epage>805</epage><pages>797-805</pages><issn>0363-5023</issn><eissn>1531-6564</eissn><abstract>The purpose of this study was to examine the medium-term outcomes of patients undergoing proximal interphalangeal (PIP) joint arthroplasty using a pyrocarbon implant.
The study comprised an analysis of 170 PIP joint pyrocarbon arthroplasties in 99 patients with a minimum 2-year clinical follow-up. Diagnoses included inflammatory arthritis (n = 49), posttraumatic arthritis (n = 29), and osteoarthritis (n = 92). Univariate logistic regression and Kaplan-Meier survival analyses were performed.
At an average follow-up of 6 years (range, 2–14 years), 58 reoperations (34%) were required, including 36 (21%) involving implant revision surgery. The majority of revisions were performed for either dislocations (n = 16) or pain and stiffness (n = 14). The 5- and 10-year survival-free of revision surgery rates were 79% and 77%, respectively. The risk for revision surgery was higher in patients with posttraumatic arthritis. There were 15 intraoperative complications involving a fracture and 26 postoperative complications, including 21 dislocations. In unrevised implants, patients had significant improvements in their preoperative to postoperative pain levels, with no change in their PIP joint total arc of motion. At a mean radiographic follow-up of 5.4 years, there were 28% with grade 3+ loosening and 36% with progressive implant instability. Implant loosening or progressive instability was not associated with worse pain or PIP joint total arc of motion.
Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. Furthermore, 1 in 4 PIP joint arthroplasties will have grade 3+ radiographic loosening and 1 in 3 will have progressive loosening or subsidence by 5 years. These results are particularly concerning in young patients and those with posttraumatic arthritis. Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained.
Therapeutic IV.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30172276</pmid><doi>10.1016/j.jhsa.2018.06.020</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9363-2768</orcidid><orcidid>https://orcid.org/0000-0003-0390-1018</orcidid><orcidid>https://orcid.org/0000-0001-8466-5154</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Factors Aged Aged, 80 and over Arthritis - surgery arthroplasty Arthroplasty, Replacement, Finger Carbon Female Finger Joint - diagnostic imaging Finger Joint - surgery Follow-Up Studies Hand Strength Humans Intraoperative Complications Joint Prosthesis Male Middle Aged PIP Postoperative Complications Proximal interphalangeal joint pyrocarbon Radiography Range of Motion, Articular Reoperation - statistics & numerical data Retrospective Studies Risk Factors Young Adult |
| title | Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties |
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