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. 2021 Oct;30(10):2361-2369.
doi: 10.1016/j.jse.2021.01.032. Epub 2021 Mar 4.

Poor results after pyrocarbon interpositional shoulder arthroplasty

Yoshihiro Hirakawa  1 , Gabriella E Ode  2 , Pierre Le Coz  3 , Shinzo Onishi  4 , Laurent Baverel  5 , Mathieu Ferrand  5 , Philippe Collin  6
Affiliations

Poor results after pyrocarbon interpositional shoulder arthroplasty

Yoshihiro Hirakawa et al. J Shoulder Elbow Surg. 2021 Oct.

Abstract

Background: This study aimed to describe the clinical outcomes and complications of 10 cases of pyrocarbon interposition shoulder arthroplasty (PISA).

Methods: The clinical and radiographic records of 10 patients who underwent PISA using the InSpyre shoulder prosthesis (Tornier-Wright) between July 2012 and March 2017 were reviewed. The mean age at surgery was 55 years. Surgical indications included patients aged <60 years with Walch type B glenoid glenohumeral osteoarthritis (n = 7), avascular necrosis (AVN) of the humeral head (n = 1), or secondary severe glenohumeral osteoarthritis with axillary nerve dysfunction (n = 2). Outcomes of interest were postoperative complications and need for revision surgery, preoperative and postoperative patient-reported outcomes (Constant score [CS] and Subjective Shoulder Value [SSV]), and range of motion. The radiographic characteristics of the implants were evaluated.

Results: Among the 10 patients, 5 underwent revision to reverse shoulder arthroplasty during the study period owing to poor clinical outcomes based on the CS and SSV. All 5 revised patients had Walch type B glenoid morphology at the time of the index procedure. The mean time to revision surgery in this subset of patients was 60 months. The remaining 5 patients who did not undergo any revision procedure had significant improvement in mean CS and SSV from 30-65 points and 32%-87%, respectively, but at a shorter duration of follow-up of 35 months.

Conclusion: High clinical failure rate and poor results at mean 5-year follow-up were found in younger PISA patients with baseline Walch B glenohumeral osteoarthritis. We would caution against use of PISA in this challenging patient population. PISA yielded more favorable short-term outcomes in patients with humeral-sided deformity or severe secondary glenohumeral osteoarthritis with axillary nerve dysfunction; however, longevity of the implant in this population remains unclear.

Keywords: Glenohumeral arthritis; interposition arthroplasty; pyrocarbon; pyrolytic carbon; shoulder; shoulder arthroplasty.

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