Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes

James Logan; Susan E. Peters; Ruby Strauss; Silvia Manzanero; Gregory B. Couzens; Mark Ross

doi:10.1055/s-0040-1714685

Journal of Wrist Surgery, Table of Contents

J Wrist Surg 2020; 9(06): 509-517
DOI: 10.1055/s-0040-1714685

Scientific Article

Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes

James Logan

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

²Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

,

Susan E. Peters

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

³Harvard Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

,

Ruby Strauss

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

,

Silvia Manzanero

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

,

Gregory B. Couzens

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

²Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

⁴Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia

,

Mark Ross

¹Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Wickham Terrace, Brisbane, Queensland, Australia

²Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

⁵School of Medicine, The University of Queensland, St Lucia, Queensland, Australia

› Author Affiliations

Abstract

Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI.

Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible.

Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants.

Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI.

Level of Evidence This is a Level III, prospective observational cohort study.

Keywords

thumb - trapeziometacarpal joint - pyrocarbon - total joint arthroplasty

Full Text

References

References
1 Peyron JG. Osteoarthritis. The epidemiologic viewpoint. Clin Orthop Relat Res 1986; (213) 13-19
2 Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD. Trapeziectomy alone, with tendon interposition or with ligament reconstruction?. J Hand Surg [Br] 1997; 22 (06) 689-694
3 Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am 2004; 29 (06) 1069-1077
4 Taylor EJ, Desari K, D'Arcy JC, Bonnici AV. A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg [Br] 2005; 30 (01) 45-49
5 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (08) 1655-1666
6 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
7 Weilby A. Tendon interposition arthroplasty of the first carpo-metacarpal joint. J Hand Surg [Br] 1988; 13 (04) 421-425
8 Heyworth BE, Jobin CM, Monica JT, Crow SA, Lee JH, Rosenwasser MP. Long-term follow-up of basal joint resection arthroplasty of the thumb with transfer of the abductor pollicis brevis origin to the flexor carpi radialis tendon. J Hand Surg Am 2009; 34 (06) 1021-1028
9 De Smet L, Van Meir N, Verhoeven N, Degreef I. Is there still a place for arthrodesis in the surgical treatment of basal joint osteoarthritis of the thumb?. Acta Orthop Belg 2010; 76 (06) 719-724
10 Parker WL, Linscheid RL, Amadio PC. Long-term outcomes of first metacarpal extension osteotomy in the treatment of carpal-metacarpal osteoarthritis. J Hand Surg Am 2008; 33 (10) 1737-1743
11 Futami T, Nakamura K, Shimajiri I. Osteotomy for trapeziometacarpal arthrosis. 4(1-6) year follow-up of 12 cases. Acta Orthop Scand 1992; 63 (04) 462-464
12 Wilson JN, Bossley CJ. Osteotomy in the treatment of osteoarthritis of the first carpometacarpal joint. J Bone Joint Surg Br 1983; 65 (02) 179-181
13 Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease. Ligament reconstruction or thumb metacarpal extension osteotomy?. Hand Clin 2001; 17 (02) 197-205
14 Vitale MA, Taylor F, Ross M, Moran SL. Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon). Hand Clin 2013; 29 (01) 37-55
15 Ferrari B, Steffee AD. Trapeziometacarpal total joint replacement using the Steffee prosthesis. J Bone Joint Surg Am 1986; 68 (08) 1177-1184
16 Hannula TT, Nahigian SH. A preliminary report: cementless trapeziometacarpal arthroplasty. J Hand Surg Am 1999; 24 (01) 92-101
17 Swanson AB, deGoot Swanson G, Watermeier JJ. Trapezium implant arthroplasty. Long-term evaluation of 150 cases. J Hand Surg Am 1981; 6 (02) 125-141
18 Nilsson A, Liljensten E, Bergström C, Sollerman C. Results from a degradable TMC joint Spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am 2005; 30 (02) 380-389
19 Ross M, James C, Couzens G, Klawitter J. 19 - Pyrocarbon small joint arthroplasty of the extremities. In: Revell PA. ed. Joint Replacement Technology. Cambridge, England: Woodhead Publishing; 2014: 628-673
20 De Smet L, Sioen W, Spaepen D, Van Ransbeeck H. Total joint arthroplasty for osteoarthritis of the thumb basal joint. Acta Orthop Belg 2004; 70 (01) 19-24
21 Gangopadhyay S, McKenna H, Burke FD, Davis TR. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37 (03) 411-417
22 Pellegrini Jr VD, Parentis M, Judkins A, Olmstead J, Olcott C. Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study. J Hand Surg Am 1996; 21 (01) 16-23
23 Tomaino MM. Basal metacarpal osteotomy for osteoarthritis of the thumb. J Hand Surg Am 2011; 36 (06) 1076-1079
24 Bellemère P, Gaisne E, Loubersac T, Ardouin L, Collon S, Maes C. Pyrocardan implant: free pyrocarbon interposition for resurfacing trapeziometacarpal joint. Chir Main 2011; (30) S28-S35
25 Cook SD, Beckenbaugh RD, Redondo J, Popich LS, Klawitter JJ, Linscheid RL. Long-term follow-up of pyrolytic carbon metacarpophalangeal implants. J Bone Joint Surg Am 1999; 81 (05) 635-648
26 Cook SD, Thomas KA, Kester MA. Wear characteristics of the canine acetabulum against different femoral prostheses. J Bone Joint Surg Br 1989; 71 (02) 189-197
27 Klawitter JJ, Patton J, More R, Peter N, Podnos E, Ross M. In vitro comparison of wear characteristics of PyroCarbon and metal on bone: shoulder hemiarthroplasty. Shoulder Elbow 2018; 0 (00) 1758573218796837
28 MacDermid JC, Tottenham V. Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther 2004; 17 (01) 18-23
29 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
30 Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Manual Manip Ther 2009; 17 (03) 163-170
31 R Development Core Team. R: A Language and Environment for Statistical Computing. 2013 http://www.R-project.org/ . Accessed June 27, 2020
32 Kazmers NH, Hippensteel KJ, Calfee RP. et al. Locking plate arthrodesis compares favorably with LRTI for thumb trapeziometacarpal arthrosis: early outcomes from a longitudinal cohort study. HSS J 2017; 13 (01) 54-60
33 Hippensteel KJ, Calfee R, Dardas AZ, Gelberman R, Osei D, Wall L. Functional outcomes of thumb trapeziometacarpal arthrodesis with a locked plate versus ligament reconstruction and tendon interposition. J Hand Surg Am 2017; 42 (09) 685-692
34 Bamberger HB, Stern PJ, Kiefhaber TR, McDonough JJ, Cantor RM. Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg Am 1992; 17 (04) 605-611
35 MacDermid JC, Roth JH, Rampersaud YR, Bain GI. Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb. Can J Surg 2003; 46 (02) 103-110
36 Minamikawa Y, Peimer CA, Ogawa R, Howard C, Sherwin FS. In vivo experimental analysis of silicone implants on bone and soft tissue. J Hand Surg Am 1994; 19 (04) 575-583
37 Karlsson MK, Necking LE, Redlund-Johnell I. Foreign body reaction after modified silicone rubber arthroplasty of the first carpometacarpal joint. Scand J Plast Reconstr Surg Hand Surg 1992; 26 (01) 101-103
38 Creighton Jr JJ, Steichen JB, Strickland JW. Long-term evaluation of Silastic trapezial arthroplasty in patients with osteoarthritis. J Hand Surg Am 1991; 16 (03) 510-519
39 van Cappelle HG, Elzenga P, van Horn JR. Long-term results and loosening analysis of de la Caffinière replacements of the trapeziometacarpal joint. J Hand Surg Am 1999; 24 (03) 476-482
40 Ledoux P. [Failure of total uncemented trapeziometacarpal prosthesis. A multicenter study]. Ann Chir Main Memb Super 1997; 16 (03) 215-221
41 Regnard PJ. Electra trapeziometacarpal prosthesis: results of the first 100 cases. J Hand Surg [Br] 2006; 31 (06) 621-628
42 Martinez de Aragon JS, Moran SL, Rizzo M, Reggin KB, Beckenbaugh RD. Early outcomes of pyrolytic carbon hemiarthroplasty for the treatment of trapezial-metacarpal arthritis. J Hand Surg Am 2009; 34 (02) 205-212
43 Bellemère P, Ardouin L. Pi2 spacer pyrocarbon arthroplasty technique for thumb basal joint osteoarthritis. Tech Hand Up Extrem Surg 2011; 15 (04) 247-252
44 Mariconda M, Russo S, Smeraglia F, Busco G. Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up. J Hand Surg Eur Vol 2014; 39 (06) 604-610
45 Maru M, Jettoo P, Tourret L, Jones M, Irwin L. Thumb carpometacarpal osteoarthritis: trapeziectomy versus pyrocarbon interposition implant (Pi2) arthroplasty. J Hand Surg Eur Vol 2012; 37 (07) 617-620
46 Cheval D, Sauleau V, Moineau G, Le Jacques B, Le Nen D. [Total trapeziectomy and suspension ligamentoplasty: is there any interest to interpose a pyrocarbon Pi2® implant?]. Chir Main 2013; 32 (03) 169-175
47 Szalay G, Meyer C, Scheufens T, Schnettler R, Christ R, Schleicher I. Pyrocarbon spacer as a trapezium replacement for arthritis of the trapeziometacarpal joint; a follow-up study of 60 cases. Acta Orthop Belg 2013; 79 (06) 648-654
48 van Aaken J, Holzer N, Wehrli L, Delaquaize F, Gonzalez IA, Beaulieu JY. Unacceptable failure of the PI2® implant. J Hand Surg Eur Vol 2016; 41 (09) 917-922
49 Scheker LR, Boland MR. Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis. Eur J Plast Surg 2004; 27 (04) 185-193
50 Lauwers TM, Brouwers K, Staal H, Hoekstra LT, van der Hulst RR. Early outcomes of Pyrocardan^® implants for trapeziometacarpal osteoarthritis. Hand Surg Rehabil 2016; 35 (06) 407-412
51 Odella S, Querenghi AM, Sartore R, DE Felice A, Dacatra U. Trapeziometacarpal osteoarthritis: pyrocarbon interposition implants. Joints 2015; 2 (04) 154-158
52 Glasson J-M, Gravier R, Duke P, Ross M. Hémiarthroplasties de resurfaçage en pyrocarbone de l'épaule. Résultats préliminaires (1 à 3ans) d'une étude prospective et multicentrique. Revue de Chirurgie Orthopédique et Traumatologique [Pyrocarbon shoulder resurfacing hemiarthroplasties. Preliminary results (1–3 years) from a prospective, multicenter study]. 2013; 99 (07) S363