OBJECTIVE: This retrospective, observational study aimed to assess the revision rates and survival curves in total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) patients, including a sub analysis to investigate the impact of pyrocarbon humeral head in revision rates.
METHODS: Data from 92 primary HSA and 508 primary TSA patients performed by seven surgeons at a large private clinic, were analyzed. The study focused on revision rates and identified factors leading to revisions, including rotator cuff insufficiency, dislocation, aseptic loosening, implant material, and glenoid erosion.
RESULTS: The overall revision rate for HSA was found to be significantly higher at 7.6% compared to TSA at 1.2% with a maximum follow-up of seven years. Sub-analysis within the HSA group revealed a notably higher revision rate in cases involving a metal head (cobalt-chrome or titanium) at 12.8% compared to those with a pyrocarbon head (2.3%).
CONCLUSIONS: This study underscores the importance of distinguishing between TSA and HSA when evaluating shoulder arthroplasty outcomes. The significantly higher revision rate in HSA, particularly with metal heads, suggests the need for careful consideration of implant selection to optimize long-term success in shoulder arthroplasty procedures.

Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.

Arthroplasty of the small joints of the hand and fingers is a complex problem facing the hand surgeon. Pyrocarbon implants have been available for several decades. They were originally thought to provide better functional outcomes than silicone implants in patients, mostly due to recreation of the joint anatomy. In a recent publication, pyrocarbon proximal interphalangeal joint (PIPJ) arthroplasty was found to have a higher complication and revision rate. We present a patient with pyrocarbon metallosis of the PIPJ in a revision arthroplasty procedure. Level of Evidence: Level V (Therapeutic).

BACKGROUND: The MoPyc radial head arthroplasty (RHA) is a monopolar implant with a pyrocarbon head that obtains rigid fixation via controlled expansion of the titanium stem. The aim of this study was to evaluate the short to midterm outcomes of MoPyc RHA.
METHODS: Between 2002 and 2021, 139 MoPyc RHA were implanted in 139 patients with a RH fracture. The mean follow-up was 5.9 years ±3.5 (range 1-16). Range of motion, mean Mayo Elbow Performance score (MEPS), quick disabilities of the Arm, Shoulder and Hand (quickDASH) score, visual analog scale (VAS), radiographic outcome, and reason for failure were recorded.
RESULTS: The mean MEP, QuickDASH, and VAS scores were 89.1± 2.2(range, 45-100), 17.5±16.7(range, 0-78), and 0.8±1.6(range, 0-50), respectively. Stress shielding (SS) and osteolysis around the stem (OAS) were identified in 92(66%) and 20(14%) patients. A total of 47(29%) patients experienced at least one complication; and 29(21%) of them required re-intervention. Persistent stiffness (n=12;9%) was the most common complication. No painful loosening was noted. Osteolysis around the stem, presence of an autoexpanding stem, and overstuffing were associated with a lower MEPS and an increase in VAS (p<0.05). Stress shielding (SS) was associated with an increase in MEPS (aβ=6.92; p<0.001) and lower VAS (aβ=-0.69; p=0.016). The auto-expending stem increased the likelihood of SS after RHA (aOR=1.49; p=0.001).
CONCLUSIONS: A well-fixed MoPyc RHA provided satisfactory short to midterm outcomes, without painful loosening. However, the autoexpanding stem system was associated with poorer functional outcomes and increased the likelihood of SS.

A 54-year-old male with osteoarthritis of the right long finger metacarpophalangeal joint underwent PyroCarbon joint arthroplasty. Seven years later the patient presented for metacarpophalangeal joint swelling and pain. The workup was benign, without signs of implant complication or osseous abnormality. He underwent washout and two-stage revision, where gross implant wear and debris not demonstrated by radiograph were found. He then returned to the operating room for reimplantation of a PyroCarbon implant.
This case demonstrates a novel presentation of aseptic PyroCarbon implant failure in the hand without radiographic abnormality that can alter operative management by reducing operating room returns.

Kienbock disease, or avascular necrosis of the lunate, is an uncommon cause of a painful and stiff wrist. Management options range from conservative treatment in the form of immobilization and corticosteroid injections to a wide variety of surgical treatments that depend on the structural integrity of the lunate, intercarpal relationships, and the condition of the articular cartilage of the wrist. A particularly difficult problem lies in the management of young patient in whom vascularized bone grafting of the lunate has failed but in whom arthritis has not yet developed. Pyrocarbon lunate implant arthroplasty is a newer treatment option for such a patient, and allows the preservation of the remainder of the proximal carpal row while directly addressing the degenerative lunate. This article describes the evidence and surgical technique for lunate implant arthroplasty and presents an illustrative case example.

UNASSIGNED: The aim of this study is to report the radiological glenoid modifications and clinical outcomes at 3 years mean follow-up of hemi shoulder arthroplasty (HA) with pyrocarbon (PYC) humeral head. Our hypothesis was that the PYC implants would provide good outcomes without major glenoid erosion. Additionally, we hypothesized that HA-PYC allowed for remodeling of the bone.
UNASSIGNED: Patients underwent HA with PyC humeral head for treatment of primary or secondary osteoarthritis, excluding post-traumatic cases. All patients had a Constant Score assessed preoperatively and at the last follow-up. Preoperative and postoperative computed tomography scans at the last follow-up were performed to achieve 3-dimensional reconstructions of the scapulae. Deformities of the glenoid surface were analyzed as a distance differential between postoperative and preoperative to investigate potential bone remodeling vs. glenoid erosion. The subluxation index (SLI) was measured.
UNASSIGNED: We included 41 patients implanted with a HA-PYC. Average age at the time of implant was 63.8 (40 to 79 years). All patients were followed for ≥2 years with an average follow-up of 36.3 months (24 to 60 months). Constant Scores increased from 34 at baseline to 80 at the last follow-up points on average (P < .01). Return to work rate was 100% and 96% had resumed their physical activity. Ten (77%) of the 13 patients with posterior head subluxation had normalized their SLI. Furthermore, no significant differences were detected between the individuals having corrected their posterior subluxation and the others (preoperative SLI between 0.45 and 0.55). Glenoid wear is less than 0.6 mm at 3 years mean follow-up, ie, 5 times less than metallic implants. A tendency to recenter the head in the anteroposterior plane was found in type B glenoid, without increased erosion of the glenoid, with very good clinical results. We did not find any difference according to age or glenoid type for clinical and radiological results.
UNASSIGNED: HA-PYCs give, in the short term, excellent clinical results in terms of pain and function. The development of a precise and objective measurement method has made it possible to demonstrate that the glenoid surface is the site of modifications that may be part of bone remodeling or progression of the osteoarthritis disease.

BACKGROUND: Pyrocarbon promises to be an optimal material choice for radial head arthroplasty (RHA) due to an elastic modulus comparable to the radial diaphysis and thus providing higher biocompatibility. Primary objective was to determine the complications and revision rates related to the usage of these prostheses. The secondary objective was to assess the clinical and radiological outcomes of Pyrocarbon RHAs.
OBJECTIVE: Pyrocarbon RHAs have good clinical and radiological outcomes with low complications and revisions.
METHODS: Ovid MEDLINE and Embase databases were used to search for studies on outcomes and complications of the RHAs using Pyrocarbon radial head prostheses. The systematic review was designed in accordance with the PRISMA guidelines and included studies were appraised using the MINORS tool. Complications and RHA revision rates were assessed. Functional outcomes were reviewed using PROMs (like MEPI, DASH and BMS), post-op range of motion (using goniometer) and grip strength (using the dynamometer). Postoperative radiological outcomes like peri-prosthetic lucency, radial neck osteolysis, radio-capitellar congruence, capitellar erosion, overstuffing/understuffing and osteoarthritis were reported using radiographs.
RESULTS: A total of 12 studies cumulatively reporting 353 patients who underwent Pyrocarbon RHAs were included in the review. The mean age of patients across the studies ranged from 47 to 54 years of which 50.5% were males. The majority of radial head replacements were done for acute trauma (87.5%) with the remainder done for arthritis (1.7%) and trauma sequelae (10.8%). Mean follow-up period in the selected studies ranged from 18 to 110 months with minimum follow-up across all studies being 12 months. Modular Pyrocarbon (MoPyC, Tornier™) was the implant of choice in ten studies while two studies used the Ascension Pyrocarbon radial head (Ascension Orthopaedics™). Ten studies demonstrated mean MEPI ranging from 75.5 to 96. Mean extension deficit ranged from 6 to 19 degrees, mean flexion from 120 to 140 degrees, mean pronation from 71 to 87 degrees and mean supination from 63 to 85 degrees. Relative grip strength ranged from 69 to 96% of the contralateral limb. Revisions due to implant-related reasons (intra-prosthetic dissociation, prosthetic fracture, peri-prosthetic loosening, radio-capitellar subluxation and understuffed/overstuffed elbow) was 6.8% (24/353). Radial stress shielding and peri-prosthetic lucency was reported in 10 to 100% of patients across different studies but symptomatic implant loosening leading to revision remained rare (2%, 7/353). Radio-capitellar congruence was reported in 81% to 100% cases while capitellar erosion ranged from 0% to 89%. Pyrocarbon implants specific complications included head-neck intra-prosthetic decoupling (1.1%) and pyrocarbon head fractures (0.9%). In total, 5.7% cases underwent re-surgery due to non-RHA related reasons.
CONCLUSIONS: The pyrocarbon RHA shows good functional outcome, range of motion and low revision rates. This aligns with the working hypothesis of this review. However, pyrocarbon radial head implants have implant-specific complications like pyrocarbon radial head fractures and intra-prosthetic decoupling between stem and head. Despite promising in vitro biomechanical properties, capitellar wear is still a common finding with pyrocarbon RHAs. Despite these factors, pyrocarbon radial head implants are a viable option for radial head arthroplasty.
METHODS: II; Systematic review.

暂无摘要。

Background  New and improved surgical techniques are warranted to treat osteoarthritis of the thumb carpometacarpal joint (CMC-1). The Pyrocardan implant yields striking results but only few series exist, making the evidence scarce. Purpose  The aim of this study was to conduct a prospective series using the Pyrocardan implant. Methods  We compared the outcomes to a matched historical control group of patients operated on with ligament reconstruction and tendon interposition. The hypothesis was that the Pyrocardan implant would yield better patient-reported outcomes as well as the procedure would be safe and effective in relieving symptoms of CMC-1 osteoarthritis. In total, 30 patients were included in the prospective series. These 30 patients were compared, in a 1:3 design, to a matched historical group. Results  Results were promising with visual analogue scale scores of 0.7 (rest) and 2.1 (function), key-pinch score of 5.1 kg, and shortened Disability of the Arm, Shoulder, and Hand score of 14.3 after 1 year when using the Pyrocardan implant. The revision rate was 10%. We found no evidence of subsidence of the thumb. We found no differences in patient-reported outcomes between the two groups. Conclusions  In conclusion, the Pyrocardan implant is a viable option in the treatment of CMC-1 osteoarthritis but with a significant revision rate. When comparing the Pyrocardan implant to a historical control group, we failed to find any differences in patient-reported outcomes. Level of Evidence  IV - case series.