Pyrocarbon Arthroplasty: An Innovative Alternative for Advanced Post-Traumatic Hamatometacarpal Arthritis

Abstract

Background: Post-traumatic arthritis of the hamatometacarpal complex (HMC) is a very rare disease and it occurs as an early secondary effect to undiagnosed or non-well treated fractures or fracture/dislocations of the 5 th metacarpal basis. It frequently occurs to young patients and manual workers requiring an important strength and hand mobility.Treatment is not consensual and ranges from medical management to intermetacarpal arthrodesis.We propose an alternative technique: A pyrocarbon arthroplasty. Hypothesis:The main objective was to assess the clinical and radiographical results of the pyrocarbon arthroplasty in the case of post-traumatic arthritis of the hamatometacarpal (HM) joint at a mean follow up of 20 months.Methods: Between 2014 and 2016, we reported the case of 4 patients suffering from a post-traumatic HM arthritis. The population include 4 men, the average age was 41-years-old (35-51). The dorsal approach procedure was performed, then a 2 mm resection of the hamate and the 5 th metacarpal basis was performed, implant sizes (STPI Tornier, initially used for scaphotrapeziotrapezoid arthritis) were tried before setting up the definitive component. During the last followup, we assessed the pain (VAS pain score), DASH score, average grip strength on both hands patients satisfaction, and return to work time. On AP X-rays and stress views, we were assessed luxations, subluxations or osteoarthritis signs.Results: With a mean follow-up of 20 months, the average VAS pain score was 2 (0-6), the average DASH was 8.75 (0-15) and the average grip strength was 69.75% (55-96) compared to the contralateral side.All patients declared to be satisfied or very satisfied by the surgical procedure and the average return-to-work time was 2 months.All patients were able to go back to their work without any professional reclassification.No patients declared to have had postoperative complications.Radiological examinations displayed a good position of the implant and no further evolution of carpometacarpal arthritis. Conclusion:Pyrocarbon implant in case of hamatometacarpal arthritis is an easy and safe procedure which offered promising results concerning satisfaction, functionality and hand strength in young and manual-workers patients. The sample is small and previous studies about surgical solution for this disease are too heterogeneous to compare the different procedures. Preliminary results are satisfying. It could be an option to consider for patients with an advanced disease of this joint.