PyroCarbon Implant Hemiarthroplasty for Trapeziometacarpal Arthritis

Abstract

The trapeziometacarpal joint is commonly affected by degenerative arthritis, presenting with pain, stiffness, and swelling at the base of the thumb. When conservative treatment fails, surgical intervention may be warranted based on clinical and radiologic staging as well as patient demand. The concept of replacing the trapeziometacarpal joint remains attractive because of the decreased pain and stiffness, prevention of thumb shortening, and earlier recovery of strength seen with implant arthroplasty. A technique of using a cementless PyroCarbon hemiarthroplasty implant that allows excellent range of motion and decreased postoperative stiffness and pain is presented, with a focus on dorsal capsular reconstruction to prevent subluxation of the implant.

Management of Osteoarthrosis of the Thumb Joints

“…46 Pyrocarbon implants were introduced more recently. 47 Early follow-up suggests reasonable results. 48 It is too early to determine whether these implants will experience similar failures encountered with implants composed of other materials.…”

Pyrocarbon small joint arthroplasty of the extremities

“…It is indicated only when there is minimal deformity of the trapezium and extreme caution is advised when there is any joint subluxation [59,60]. Variable short-term results have been reported with this implant.…”

Surgical Treatment of Trapeziometacarpal Joint Arthritis: A Historical Perspective

“…The great compressive forces to which these prostheses were subject led to frequent loosening and osteolysis. More recently, and mirroring the evolution of small joint implant material technology, several pyrocarbon implants have been introduced [38]. Advocates for resurfacing procedures point to the potential benefit of preserving some trapezium so that more salvage options remain should the implant fail.…”

“…The less complicated procedures that achieve this simple goal continue to be performed, such as hematoma-distraction arthroplasty [17]. There continue to be advocates for prosthetic arthroplasty using various designs [6,30,31,38], with reports of good clinical results including, for one design, a 5-year survival rate of 95% [10]. Most current reports are from European surgeons [21,22,31], a consequence of the difficulty in obtaining FDA approval for many of the newer biomaterials and designs.…”