Pyrolytic Carbon Hemiarthroplasty for Proximal Interphalangeal Joint Arthritis, Long-Term Follow-Up

Purpose: The purpose of this study was to assess the long-term clinical, subjective, and radiographic results of pyrocarbon hemiarthroplasty for proximal interphalangeal joint (PIPJ) arthritis at a single institution.

Methods: Patients treated with a pyrolytic carbon hemiarthroplasty between 2005 and 2015 were contacted for a clinical follow-up visit. Patients were assessed before surgery, one year after surgery, and again after a mean of 11 years (range: 6-16 years). Objective outcomes were assessed with grip strength, pinch strength, and range of motion (ROM). Subjective outcomes were assessed by the Disabilities of the Arm, Shoulder, and Hand score, Canadian Occupational Performance Measure (performance and satisfaction), and Visual Analog Scale pain scores at rest and during activity. Radiographic assessments were completed according to Sweets and Stern as modified by Wagner et al.

Results: A total of 68 fingers in 52 patients underwent PIPJ hemiarthroplasty. Thirty-six arthroplasties in 29 patients were available for the long-term follow-up, five patients had died, and the remaining cases were contacted by phone. Three cases were lost to follow-up. Preoperative diagnoses included 41 fingers with osteoarthritis or posttraumatic arthritis, and 27 fingers with inflammatory arthritis. Eight cases had undergone revision at the time of follow-up, and the 10-year implant survival was 72%. The revisions were performed after a mean of two years after surgery. Three patients had undergone soft-tissue procedures. Visual Analog Scale pain scores, Disabilities of the Arm, Shoulder, and Hand scores, and Canadian Occupational Performance Measure scores improved significantly compared with that before surgery. Grip strength and pinch grip remained unchanged. However, PIPJ ROM deteriorated significantly one year after surgery, when compared with that before surgery.

Conclusions: Pyrocarbon hemiarthroplasty of the PIPJ has an acceptable long-term implant survival, and the significant improvement in pain scores and patient-reported outcomes is maintained over time. Pyrocarbon hemiarthroplasty could be a viable option in the management of PIPJ arthritis. Patients should be advised that PIPJ ROM deteriorates over time.

Type of study/level of evidence: Therapeutic IV.