Table 2 Alternative methods and reported outcome
Author | Study design | Joint | Implant | No. of Joints/ Patients | Mean age at surgery (years) | Follow-up (years) | ROM (pre-postop) | Pain | Cause for surgery (No. of Joints) | Out-come | Conclusion And Summary |
|---|---|---|---|---|---|---|---|---|---|---|---|
Goldfarb 2003[39] | Case Series | MCP | Silicon | 208/36 | 52 | 14 | 30° to 36° | 27% pain-free | RA (208) | 7% revisions 63% implant fracture | High rate of implant fractures |
Chan 2013[40] | Systematic Review | PIP | Silicon Pyrocarbon | 1430/x 452/x | 53 58 | 0.5–23 1.1–5 | 29° to 37° 37° to 45° | 76% pain-free 64% pain-free | Posttraumatic (663) RA (406) OA (193) Others (65) Posttraumatic (30) RA (22) OA (158) | 4% revision 2% salvage surgery 14% revision 8% salvage surgery | High number of joints Differences in study design and parameters make comparisons difficult. Revision and salvage rates almost 4 times higher in the pyrocarbon group |
Boe 2018[41] | Case Series | MCP | Silicone | 325/113 | 64 | 7.2 | 33° to 43° | 94% none or only mild pain | RA (309) OA (11) Posttraumatic (5) | 7% revision 37% implant fracture in whole cohort 32% implant fracture at 10y 65% implant fracture at 15y | Progressive risk of implant fracture over time Implant fracture had no bearing on clinical outcomes |
Cook 1999[42] | Case Series | MCP | Pyrocarbon | 151/53 71/26 available for follow-up | 58 | 11.7 | 39° to 52° | Not available | RA (62) Posttraumatic (4) others (3) | 12% revision 70% 16 years survival | High loss to follow-up (53% of the patients) |
Sweets 2011[43] | Case Series | PIP | Pyrocarbon | 31/17 | 64 | 4.6 | X° to 31° (0–100) | Average VAS 3 (0–7) | OA (31) | 19% revision 48% loosening 16% dislocation | High follow-up (100%) In total 75% revision, loosening or dislocation |
Pritsch 2011[44] | Case Series | PIP | Pyrocarbon CoCr-UHMWPE | 203/x 91/x | 51 (at revision, the whole study cohort) | Clinical data in 48 of 76 reop cases were reviewed on average 2.3y after last reop. | 32° to 33° (In the follow-up cohort, n = 48, before first reoperation) | 39% (30/76) of the patients in the reoperation cohort reported no pain | (76 reoperations in 59 patients) OA (35) Trauma (24) Inflammatory arthritis (17) | 50 reoperations 26 reoperations | Mean time to first reoperation less than 1y. No significant change in preop vs postop ROM (reoperation cohort) Most patients (reoperation cohort) had mild or no pain |
Wagner 2018[45] | Case Series | PIP | Pyrocarbon | 170/99 | Not available | 6 | Not available | Not available | RA (49) Trauma (29) OA (92) | 34% reoperations including 21% implant revision | 1 in 5 will require revision by 5y 1 in 3 will have progressive loosening or subsidence by 5y. The results are particularly concerning regarding young patients and those with posttraumatic OA |
Mora 2020[46] | Case Series | PIP | Pyrocarbon | 29/19 | Not available | 6.4 | X° to 60° | VAS 1.6 | Not available | 24% revision | 24% revision rate at mid-term follow-up 14% implant removal after 4.6y |
Murray 2012[47] | Case Series | PIP | CoCr-UHMWPE | 67/47 | 63.5 | 8.8 | X° to 40° | VAS 3 (of 100) | OA (50) RA (17) | 12% implant failure 14 of the 31 patients that returned for clinical follow-up had complications. (4 fusions, 2 amputations) | Low pain level Higher risk for implant failure/complications in RA patients. |
Jennings 2015 [48] | Case Series | PIP | CoCr-UHMWPE | 39/21 | 62 | 9.3 | 58° to 56° | 82% less pain 18% worse pain | OA (36) RA (2) Trauma (1) | 26% revisions | Satisfaction rating 26/39 (67%) very satisfied |
Frueh 2015[49] | Systematic Review | PIP | Hemi-hamate autograft | 71 joints | Not available | 3 | 77° | Not available | PIP fractures (71) (acute and chronic) | 35% complications, 50% postop OA | High rate of postoperative OA (up to 50%) |