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. 2020 Dec;9(6):509-517.
doi: 10.1055/s-0040-1714685. Epub 2020 Aug 21.

Pyrocardan Trapeziometacarpal Joint Arthroplasty-Medium-Term Outcomes

James Logan  1   2 , Susan E Peters  1   3 , Ruby Strauss  1 , Silvia Manzanero  1 , Gregory B Couzens  1   2   4 , Mark Ross  1   2   5
Affiliations

Pyrocardan Trapeziometacarpal Joint Arthroplasty-Medium-Term Outcomes

James Logan et al. J Wrist Surg. 2020 Dec.

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: pyrocarbon; thumb; total joint arthroplasty; trapeziometacarpal joint.

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Conflict of interest statement

Conflict of Interest The Brisbane Hand & Upper Limb Research Institute receives fellowship and research funding by Medartis, LMT Surgical, Johnson & Johnson, Zimmer Biomet, Integra Life Sciences and Newclip Technics. G. B. C. reports other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, other from LMT Surgical, other from DePuy Synthes, other from Field Orthopaedics, outside the submitted work. J. L. reports other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, other from LMT Surgical, other from DePuy Synthes, outside the submitted work. S. M. reports other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, other from LMT Surgical, other from DePuy Synthes, outside the submitted work. S. P. reports other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, other from LMT Surgical, other from DePuy Synthes, outside the submitted work. M. R. reports grants, personal fees, and other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, personal fees and other from LMT Surgical, personal fees, and other from DePuy Synthes, personal fees from Trimed, personal fees from Surgicraft, personal fees from Lima Orthopaedics, other from Ensemble Orthopedics, personal fees from Medartis, outside the submitted work. R. S. reports other from Integra Health Sciences, other from Zimmer Biomet, other from Newclip Technics, other from LMT Surgical, other from DePuy Synthes, outside the submitted work.

Figures

Fig. 1
Fig. 1
( A, B ) Skin incision. ( C ) Z-shaped capsulotomy to reveal first carpometacarpal joint. ( D ) Diagram showing the two capsular flaps created by the capsulotomy, the proximally based dorsoulnar capsular flap (DU), and the distally based volar–radial capsular flap (VR). MC, metacarpal; TM, trapezium.
Fig. 2
Fig. 2
( A ) A microsagittal saw or high-speed burr is used to shape the trapezium and first metacarpal to accept the prosthesis. (Reprinted with permission from Bellemère P). ( B ) Diagram demonstrating the perpendicular convex surfaces created by the bone cuts. Lat, lateral; MC, metacarpal; PA, posteroanterior; TM, trapezium.
Fig. 3
Fig. 3
( A ) Trial implant. The correct size should cover the entire trapezium and be stable when performing a full passive range of movement under image intensifier screening. ( B ) The trial is replaced with the corresponding definitive implant. Note the black unmarked definitive implant sitting in the 15 mm slot with the purple15 mm trial sitting on the tray. This makes aligning the unmarked prosthesis far simpler.
Fig. 4
Fig. 4
( A–C ) The capsule is repaired with 1 mm all suture Juggerknot anchors. ( D ) Diagram showing anchor placement. DU, dorsoulnar capsular flap; MC, metacarpal; TM, trapezium; VR, volar–radial capsular flap.
Fig. 5
Fig. 5
Collinear alignment of the carpometacarpal joint is restored.
See this image and copyright information in PMC

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