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%) |
RA Rheumatoid arthritis
OA Osteo arthritis
CoCr Cobalt Chrome
UHMWPE Ultra-high-molecular-weight polyethylene