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A-1176 Pyrocarbon MCP and PIP joint arthroplasty – what are the benefits
Sumedh Talwalker, Wrightington, UK
Friday, June 15, 2018 · 2:15 p.m. · 14m 54s
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um i'm straight double car like to thank all been for inviting me for this with all
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this talk of like to shave it to our experience using particle button at the p.
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i. p. and e. m. c. p. level um these are the so called third generation
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devices um which a minimally constrained to depend on the native anatomy for to work
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and they are supposed to the store the anatomical centre of rotation
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a dark auburn itself as a material starts off as a soft
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hydrocarbon bead which then by process applied all this is
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all customisation becomes harder underscore part of it to carbon now
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this is been around for quite a long time it
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was used in these nuclear waste enclosures and has been used over the years very successfully in heart valves
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uh as far as the profile is concerned and the um commercially available implant seconds and what
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we have is a a a central core of graphite in which the at constant
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and uh the sofas itself is coated over with a a proprietary shiny um carbon
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um and like kevin said these do appear extremely pretty a formal seductively so
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as far as the properties are concerned that their characteristics in vitro a significantly superior to cobalt chromium
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uh when you look at the the elastic modulus it's comparable to bone
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and that reduces stress chilling and potentially reduces observers option
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as far as the a cyclical where against most concerned once again it tends
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to perform extremely well against the other materials as you can see
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um as far as fixations concern the service appears
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uh as above in the um uh on a electron microscope and it's generally felt that
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um you know this is a two step process the first step is the press
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fit at the second step is bony this option into this and obviously this is something
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which um i'll come too late at night we we don't necessarily agree with
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no as a unit we been involved a particle been for a long time um on
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the left side of your screen you can see all the the clinical studies
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and on the right it's work that we've done with don joyce and but
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with the help of a a grant from the um hand society
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doing basic sign studies looking at what the manufacturers has had said in terms of the way a profile
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uh so we looked a bible for prospective cohort study at our
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uh seventy two consecutive patients a ninety seven a buyer carbon
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p. i. p.'s of the minimum follow up of of five
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years the majority of operations frosty arthritic the few inflammatory
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uh and post traumatic cases we did the usual range of movement grips trends uh
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i will record a complications less than six months more than six months
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um we also did subjective evaluation using a validated scores and we did the but the pain evaluation
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as you can see we also asked nations whether they would have the same procedure done again
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so looking at the range of when one becomes apparent immediately is that there isn't a vast improvement from the the prix operate
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doing the best they can say is that we maintain the range of movement apart from the was inflammatory rheumatoid group
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um also there's no change in the range of movement from between two to five years it didn't uh wasn't clinically significant
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so what does excellent look like the maximum range of movement regatta sixty degrees
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uh the worst performance was a zero degrees to people who didn't move and if
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at all there's the willis aboard was so that was that would be
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those that hyper extension the average range of movement was thirty five degrees and
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uh how we had eleven percent too hyper extended in the small next
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we know that for hand to work properly what you need is about
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eighty degrees of flexion and less than twenty degrees of like so
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fifteen percent turn when you look at this weight close you you fifteen percent give us that more than eighty degrees of flexion and
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thirty percent of our cases had more than this a twenty degree
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lag that probably explains why some of operations at functional problems
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um but there's no correlation between this range of movement and the the function of schools
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speaking of functions cause we looked at the pam the quick dash we looked
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at a pain level is a and b. aspirations with have surgery
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um uh again and seventy one percent patients seem to feel that you know
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and then the five is that they would go ahead with sorry
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once again a statistical significance wasn't region that the school was did not
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really shift one way or the other between two one five is
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we look use they hadn't classification daniel's classification but i'm looking at reduce in c.
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and we found that there was progressive um they do something fifteen patients wanting you so with
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evidence of migration and twelve um but there's no evidence to show that you know
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clearly a fax clinical um outcome for components will however um advice for loosening
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uh i'm also called last a discussion that the shape of the curve the captain mike of
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does not lend itself to losing it's more to do with earlier failures which are related
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to technical problem so it's really off autumnal before of up iraq up when you look at
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complications seven percent only complications um of which
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large number with the post traumatic group
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uh but if you look at the the lead group more than fifty percent
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of our patients have problems uh and significant number of these weren't inflammatory
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this is what we did for some of our cases um at
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the these sorry this is some of our complications challenger fractures
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early and late dislocations um as well as the the squeaking prosthesis which is you know is second rate too
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mal alignment did it causes age loading and you can end up with a a an
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issue um as you can see hopefully there could be done the volume up
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right
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so that's what i'm discover the squeak it sounds more like a creek rather than the squeak uh but
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that's um due to age loading the the pitch off the noise that you get from uh
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by recovering in a finger is substantially different from said we can sell make that we are in
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the which is a higher pitch and that sounds more like a like a um um
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i agree um dislocations as you can see here these are difficult problems to treat because essentially when you take the prosthesis out
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you're left with these big huge canals and uh you have to bone graft these infuse them
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a small nagging can be quite catastrophic good happens more than one thing though
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even with the centre finger can be an issue once again this
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patient underwent fusion and this is angular nat problems where we have to
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go ahead and uh proceed with it the fusion as well
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when it comes to saliva ship v. had this weather ship of eighty five percent
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um at ten is uh when we used revision as an endpoint and these were some
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of the procedures that we we performed essentially broadly divided between uh replacements of revisions
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so we were able to reliably relieve pain we were able to maintain the pretty up range of movement the
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best we can say about that and the ah commotion rip spent we found it not me usually improve
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and it did not or to always an between two to five
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years um they don't read the revisions fourteen percent which
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is more than what you would see you it these it's a out the silicone prosthesis of the cemented of montana
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and when you so those fifteen that well at progressive loses if
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if they become loose further down the line and become
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significantly symptomatic even have to be looked at as well and that might have to uh the the numbers of failures
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there were problems with our study does affect respectively nature only fifty two percent we
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had all the data points and seven percent that died seven percent couldn't relocated
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and thirty two before out of my question again this is a problem with all retrospective studies so
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although you know we had excellent pain relief is the range of movement can be unpredictable
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uh and seventy percent to nobody expected uh a better satisfaction if if if you see the the previous chart it
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goes down from seventy four seventy five seventy one from the two two four five years so the high
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rate of secondary surgery seed in um park up and come back to silicone and it's something planned showing progress
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of lose thing so what does the lip to just save you have a p. just turns um optical
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made a some of our our complication talked a news article in
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two thousand six let's go back to the end up saying
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that most dramatic groups did not do as well and that
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it hadn't had commented on problems with really loosen see
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you can sense all these worries um have to be taken into consideration um david borax um
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matt analysis on p. i. p. joint outcomes found that the quality of studies wasn't very
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good with only five adequate studies identified the turn of the patients had complications
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uh and he suggested that the registry should be kept particularly with p. i. p. joints
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so moving on to our next topic which was the fire coven m. c. p. join to uh for the treatment of um
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we be exclusively use this unknown inflammatory arthritis for the
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reasons that given very clearly explained earlier um
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this is the cotton which should be used fire garden replacements i'm i'm
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i'm gonna be doing so when we had to select writing turn
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um again director prospective study and these were some of 'em
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um inclusion criteria we looked at the range of movement grips trend them sorry to part of
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this is repetitive um and we looked at a subjective criteria as you could see
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radiological assessment was done using the herons classification we have fifty one
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implants it's a much smaller coordinate thirty six consecutive patients
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eight implants were lost to follow up an awful lot was of a hundred and three months thirty six percent women
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i mean range of movement that we had was fifty four degrees the grip stance was twenty
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five kilograms force up and down the complications just seen in ten that's twenty percent patients
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uh and it was no correlations with any of the um factors that you can see on the right
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uh looking at our complications we had one patient with chronic region pain syndrome any was
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the sole patient in this court who did not want um the surgery again
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uh we have three successfully treated dislocations and the stiff joints related complications
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you can see uh how we treat them and the slide
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looking at uh in um um implants ally with analysis
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uh it's ninety seven percent is on the cap my curve at um at five years in this at two
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we're sorry that this didn't drops down to do a eighty eight percent at at the five years stage
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um once again you see that the pain scroll improves significantly a
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big improvement of it with good quick dash and pam's goes
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really logically the issues surrounding alignment and subsidence once again the the did
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not cool relate very well with our um um subjective skulls
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so what you see here is a good intermediate term result in terms of a range of movement
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function range of movement grips trend uh as well as in council level
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um when it comes to the m. c. p. joints uh let me go back i'm just like the p.
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i. p. it's very important that uh we don't get more than thirty degrees of an extensive liner
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uh and um get at least seventy degrees affection so all patients to choose the first criteria
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but uh we we partially able to achieve this in the uh in terms
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of the extensive line looking at what's published um that just turns uh
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um c. d.'s of eleven single c. d.s um up patients on with m. c. p. joint once
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again uh uh uh uh we were very good results with hundred percent return to work
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um he also had patients to squeak to um due to age loading
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um extensive sublet stations and other issues which you treated also these big c. d.'s from the mail
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a hundred and forty two a consecutive in c. p. joins which were done in a way
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remote quite an inflammatory arthritis interestingly with significantly increase region range of movement
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in pain relief um the decreasing gives rent increase in winch
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a strand and that um the complication rates as you can see about
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um an important paper from a given very comments on the m. c. p.
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joints being substantially different by mechanically which probably explains why the results um
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different from the the p. i. p. joint it's also important to underscore the fact that most hand
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surgeons even but high volume track tests one see as many m. c. p. joints is
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perhaps they would see p. l. p. joint as well as the fact that this is a
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procedure that needs to be done carefully up lots of use of the c. um
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making sure that your approach to the procedures meticulous because the margin for error all the
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greater the m. c. p. u. and i think it's still not very much so
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in conclusion as far as the m. c. p. joints are concerned we felt that the results for
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more successful this is something that we still use that writing turn for non inflammatory arthritis
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because the complications address and we get a good range of movement one of the things
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i do with patience is just show them our leader board at writing tin
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we've got the saliva ship uh for almost all all the joys and if you
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look at our at our competitors it can see that at any is
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we have ninety five percent standing you know with the leader which is the total hip
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replacement unfortunately when you add a b. m. c. p. and the p. i. p.
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um we end up at the bottom um and the next slide is even more
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sobering because when you look at the twenty five year follow up of
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uh cemented to clipping of these uh some ever put in by rob risky and murphy work
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uh john john lee's scenery just doesn't then randy unit
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some of these patients or coming back and you've got eighty five percent so that we should still at twenty five years um
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and we're just about at that level for the m. c. p. n. p. i. b. so clearly a lot of work needs to be done
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uh in two thousand and thirteen doctor back in both said this was the operation second
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song so important that they're aware of these figures that we're not as good
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i performing a out the i. p. m. c. p. john implicitly not hands at writing to adaptation should be given the
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choice and they need to be aware of this window put on on lists and then they undergo this procedure
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there are waxing and waning trends but in my opinion at least we
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haven't seen anything that would be significantly better than uh than the
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the um than the silicone a joint that given spoke about earlier um
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but it does represent and more active spectral up front yeah
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for for the uh study to look at a new enjoys thank you
Conference Program
A-1174 Introduction
Torben Bæk Hansen, Holstebro, Denmark
June 15, 2018 · 2:01 p.m.
A-1175 Silicone MCP and PIP joint arthroplasty – still the gold standard?
Kevin Chung, USA
June 15, 2018 · 2:01 p.m.
199 views
A-1176 Pyrocarbon MCP and PIP joint arthroplasty – what are the benefits
Sumedh Talwalker, Wrightington, UK
June 15, 2018 · 2:15 p.m.
155 views
A-1177 Modular PIP joint implants – why?
Philippe Bellemère, Nantes, France
June 15, 2018 · 2:31 p.m.
164 views
A-1179 Wide awake surgery in PIP and MCP total joint arthroplasty
Mike Hayton, Wrightington, UK
June 15, 2018 · 3 p.m.
118 views
