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Carofino BC. Letter to the Editor regarding Kleim et al: "pyrocarbon hemiprostheses show little glenoid erosion and good clinical function at 5.5 years of follow-up". J Shoulder Elbow Surg 2024; 33:e459-e460. [PMID: 38692403 DOI: 10.1016/j.jse.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 05/03/2024]
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Barret H, Garret J, Favard L, Bonnevialle N, Collin P, Gauci MO, Boileau P. Long-term (minimum 10 years) survival and outcomes of pyrocarbon interposition shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00479-8. [PMID: 39067661 DOI: 10.1016/j.jse.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND There are some major controversies surrounding the use and longevity of pyrocarbon interposition shoulder arthroplasty (PISA). The objective of this study was to investigate the long-term survival and outcomes (minimum 10-year) following PISA for osteoarthritis (OA) in young and active patients. METHODS This was a retrospective review of prospectively collected data of patients who underwent PISA (InSpyre; Tornier-Stryker) for OA between 2009 and 2012. Arthroplasty survival was known for 71 patients followed longitudinally for a minimum of 10 years. The clinical and radiologic outcomes were assessed in 62 patients (62 shoulders) reviewed with radiographs. The mean age at surgery was 60 years (range, 23-72 years), and 31 shoulders (50%) underwent prior surgery before PISA. The diagnosis was primary osteoarthritis (POA = 29), post-traumatic osteoarthritis (PTOA = 23), and postinstability osterarthritis (PIOA = 10). Clinical failure was defined as repeat surgical intervention involving prosthesis revision. Clinical outcomes were assessed with the Constant score (CS) and Subjective Shoulder Value (SSV). The mean duration of follow-up was 11 ± 0.6 years (range, 10-14 years). RESULTS Overall, the survival rate was 90% (95% confidence interval [CI] 82.8-96.8) at 5 years and 87% (95% CI 79-94.8) at a 10-year follow-up. Survival was 100% in PTOA (type 1 fracture sequelae) and in PIOA as well as 95% in primary OA with type A glenoid. Revision surgery was significantly higher in biconcave (type B2) glenoid (44%) compared with concentric (type A) glenoid (2%), respectively (P = .002). Among the 7 patients who were revised to reverse shoulder arthroplasty, 5 had painful glenoid erosion and 2 had bipolar (glenoid and humeral) erosion with thinning and finally fracture of the greater tuberosity. Two shoulders with glenohumeral erosion were associated with secondary rotator cuff tears (1 supraspinatus and 1 subscapularis tear). The mean time to revision and revision was 4 ± 1.7 years. Glenoid wear was more often superior (81%) than central (19%), P < .001. For those shoulders not revised, the mean CS and SSV significantly increased from 39 ± 14 to 70 ± 14 points and 34% ± 15% to 75% ± 17%, respectively (P < .001). CONCLUSION PISA is an efficient and durable surgical procedure for the treatment of young and active patients with post-traumatic OA, postinstability OA, and primary OA with concentric (type A) glenoid erosion, but not for those with biconcave (type B2) glenoid. Biconcave (type B2) glenoid and subscapularis tear or insufficiency are risk factors for failure and revision.
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Affiliation(s)
- Hugo Barret
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, France; Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | | | - Luc Favard
- Service d'Orthopédie Traumatologie, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-Tours, France
| | - Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, France; Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Philippe Collin
- Department of Orthopedic and Trauma Surgery, CHP Saint-Grégoire, Saint-Grégoire, France; Department of Orthopedic and Trauma Surgery, Clinique Victor Hugo, Paris, France; Department of Orthopedic and Trauma Surgery, American Hospital of Paris, Neuilly-sur-Seine, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, UR2CA, Côte d'Azur University, CHU de Nice, Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Reparatrice (ICR) - Locomoteur & Sport, Institute for Reconstructive Surgery, Nice, France.
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Garret J, Cuinet T, Ducharne L, Godenèche A. Pyrocarbon humeral heads for hemishoulder arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at 5-9 years of follow-up. J Shoulder Elbow Surg 2024; 33:328-334. [PMID: 37481104 DOI: 10.1016/j.jse.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Hemishoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads, which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to midterm (5-9 years). METHODS We retrieved the records of 45 consecutive patients who underwent HSA with pyrocarbon humeral heads from 2013 to 2017. Patients were evaluated radiographically and clinically at a first follow-up (2-4 years) and a second follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography scans, and glenoid erosion was assessed using plain radiographs according to Sperling et al. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) score were assessed by an independent observer. RESULTS From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion) and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At the first follow-up of 2.2 ± 0.4 years, all clinical scores improved substantially (CS from 29.3 ± 13.5 to 76.7 ± 14.4, ASES from 23.7 ± 15.6 to 87.0 ± 16.0, and SSV from 25.3 ± 12.2 to 84.1 ± 15.2), and at the second follow-up of 6.2 ± 1.2 years, good clinical scores were maintained (CS from 76.7 ± 14.4 to 80.8 ± 16.0, ASES from 87.0 ± 16.0 to 92.3 ± 15.0, and SSV from 84.1 ± 15.2 to 82.8 ± 18.3). At the second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing with immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n = 9) or 2 grades (n = 1). CONCLUSION Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.
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Affiliation(s)
| | - Thomas Cuinet
- Clinique du Parc, ELSAN, Lyon, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Louis Ducharne
- Clinique du Parc, ELSAN, Lyon, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
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Barret H, Boileau P. Can Pyrocarbon be used as a functional spacer for the treatment of recalcitrant shoulder infections? JSES Int 2024; 8:167-175. [PMID: 38312269 PMCID: PMC10837719 DOI: 10.1016/j.jseint.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The most common treatment approach in periprosthetic joint infection (PJI) and chronic shoulder joint infection (SJI) is a two-stage revision involving interval placement of an antibiotic cement spacer or a resection arthroplasty. Knowing that Pyrocarbon has a smooth surface that prevents pathogen adhesion, the question arises whether it could be used as a temporary or permanent functional spacer? Purpose The primary objective of the present study was to assess the rate of infection eradication after temporary or definitive implantation of Pyrocarbon Interposition Shoulder Arthroplasty (PISA) in patients with recalcitrant PJI or SJI. Our secondary objective was to assess mid-term clinical and radiographic outcomes. Methods Fifteen patients (mean age: 52 ± 19 years) with chronic shoulder infection underwent, after joint débridement, implantation of PISA (InSpyre; Tornier-Stryker, Kalamazoo, MI, USA) with tailored perioperative antibiotics. In 7 cases, PJI occurred after hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 2), hemireverse (n = 2), and resurfacing arthroplasty (n = 1). In 8 cases, SJI occurred in the context of failed surgery after fracture sequelae (n = 4), instability (n = 2), and cuff arthropathy (n = 2). Preoperatively, patients had a mean of 3 previous failed surgeries before PISA implantation. Patients were evaluated with clinical, laboratory, and radiographic assessment at a minimum of 2 years after surgery. Results At a mean follow-up of 55 ± 18 months, no patient experienced reinfection after temporary (3 cases) or definitive (12 cases) PISA implantation. The adjusted Constant score increased from 33% ± 20 preoperatively to 65% ± 28 at last follow-up and SSV from 22% ± 19 to 63% ± 23 (P < .001). Active forward elevation increased from 27° ± 19 to 113° ± 30, external rotation from 7° ± 21 to 25° ± 25, and internal rotation level 3 ± 2 to level 5 ± 2 points (P < . 001). On final radiographs of definitive PISA, complete humeral densification, or a neocortex, formed around the implant in 64% (7/11). Conclusion Our data suggest that, after washout, débridement and tailored antibiotics, PISA can be used as a temporary or definitive functional spacer for the treatment of recalcitrant shoulder infections and presents the following advantages: (1) PISA does not seem to be a risk for recurrent infection thanks to the antibacterial property of Pyrocarbon; (2) PISA can be used as a temporary or a definitive spacer without causing bone erosion, thanks to the low modulus of elasticity of Pyrocarbon; (3) PISA can be used as a salvage procedure in case of complete glenoid or humeral destruction, thanks to the sphericity of the implant needing no implant anchorage.
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Affiliation(s)
- Hugo Barret
- ICR-Institut de Chirurgie Réparatrice, Groupe Kantys, Nice, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice, Groupe Kantys, Nice, France
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Kleim BD, Zolotar A, Hinz M, Nadjar R, Siebenlist S, Brunner UH. Pyrocarbon hemiprostheses show little glenoid erosion and good clinical function at 5.5 years of follow-up. J Shoulder Elbow Surg 2024; 33:55-64. [PMID: 37385424 DOI: 10.1016/j.jse.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The success of traditional shoulder hemiarthroplasty (HA) with cobalt-chromium heads is limited by painful glenoid erosion with problematic bone loss. Hemiprostheses with pyrolytic carbon (PyC) heads have shown reduced glenoid erosion in experimental laboratory studies. Few in vivo data are available. METHODS We performed a single-center consecutive cohort study of 31 of 34 patients (91%) who underwent PyC HA between September 2013 and June 2018. In 11 of these patients, concentric glenoid reaming was additionally performed. The mean follow-up period was 5.5 years (range, 3.5-7 years). Standardized radiographs were taken, and clinical function (Constant score) and pain (visual analog scale score) were recorded. Anteroposterior radiographs were analyzed according to an established method by 2 independent observers: A line parallel to the superior and inferior glenoid rim was translated to the most medial point of the glenoid surface. A further parallel line was placed on the spinoglenoid notch. The distance between these 2 lines was measured. Measurements were scaled using the known diameter of the implanted humeral head component. To assess eccentric erosion, anteroposterior and axial images were classified according to Favard and Walch, respectively. RESULTS Mean medial glenoid erosion measured 1.4 mm at an average of 5.5 years of follow-up. In the first year, 0.8 mm of erosion was observed, significantly more than the average erosion per year of 0.3 mm (P < .001). Mean erosion per year was 0.4 mm in patients with glenoid reaming vs. 0.2 mm in those without reaming (P = .09). An evolution of glenoid morphology was observed in 6 patients, of whom 4 had a progression of the erosion grade. The prosthesis survival rate was 100%. The Constant score improved from 45.0 preoperatively to 78.0 at 2-3 years postoperatively and 78.8 at latest follow-up (5.5 years postoperatively) (P < .001). The pain score on a visual analog scale decreased from 6.7 (range, 3-9) preoperatively to 2.2 (range, 0-8) at latest follow-up (P < .001). There was a weak correlation (r = 0.37) between erosion and pain improvement (P = .039) and no correlation between erosion and change in Constant score (r = 0.06). CONCLUSION PyC HA caused little glenoid erosion and a sustained improvement in clinical function in our cohort at mid-term follow-up. PyC demonstrates a biphasic development of glenoid erosion, with a reduced rate after the first year. PyC HA should therefore be considered as an alternative to cobalt-chromium HA and to anatomical total shoulder arthroplasty for patients with a high risk of glenoid component complications.
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Affiliation(s)
- Benjamin D Kleim
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany; Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany.
| | - Aleksei Zolotar
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Rudolf Nadjar
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Ulrich H Brunner
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
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Franceschetti E, Gregori P, Giurazza G, Papalia G, Caraffa A, Papalia R. Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2023; 7:24715492231152143. [PMID: 36714423 PMCID: PMC9875319 DOI: 10.1177/24715492231152143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis. Results A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively. Conclusions Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients. Level of Evidence IV.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giancarlo Giurazza
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Auro Caraffa
- Department of Orthopaedic and Trauma Surgery, Perugia hospital, Perugia, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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Pyrocarbon hemiarthroplasty of the shoulder: a systematic review and meta-analysis of clinical results. J Shoulder Elbow Surg 2023; 32:1323-1332. [PMID: 36610477 DOI: 10.1016/j.jse.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/22/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hemiarthroplasty is often considered in the setting of preserved glenoid cartilage given the high risk of revision associated with total shoulder arthroplasty. Pyrocarbon (PyC) has been used as an implant material that theoretically allows for formation of a neo-membrane that would act like cartilage to reduce glenoid wear. The purpose of this study was to evaluate the clinical outcomes, radiographic outcomes, revision rates, and complication rates in the existing literature on shoulder hemiarthroplasty using PyC. METHODS The MEDLINE, Embase, and Scopus databases were searched for articles relating to shoulder hemiarthroplasty using the terms "pyrocarbon" or "pyrolytic carbon." Abstracts and articles were screened against predefined inclusion and exclusion criteria, with a minimum of 24 months' follow-up required. Data on patient demographic characteristics, clinical outcome scores, complications, revision rates, and radiographic findings were recorded. Where appropriate, meta-analysis was performed. RESULTS Twelve studies were selected for final inclusion, with a total of 536 patients. Among the studies reporting preoperative and postoperative range of motion (ROM), an overall improvement in ROM was observed. The mean Constant score was 70.9 points postoperatively, with a mean improvement of 36.2 points (n = 359, 9 studies). Radiographically, 22.8% of patients (n = 536, 8 studies) had evidence of glenoid erosion, 10.4% had changes in implant positioning, and 9.9% had tuberosity thinning. In addition, 1.5% of patients had radiographic subacromial space reduction, whereas 0.7% had an increase in tuberosity thickness. Across all studies, there was an 8.6% complication rate, with the most common cause being glenoid erosion (2.6%, n = 14). There was an overall 7.7% revision rate (n = 41), with 63% of revisions (n = 26) undergoing conversion to reverse or total shoulder arthroplasty. CONCLUSION PyC hemiarthroplasty shows overall improvements in ROM and patient-reported outcomes for patients. However, there remains concern for glenoid erosion on radiographic evaluation at minimum 2-year follow-up. Although preliminary studies have shown encouraging results, this systematic review emphasizes the need for longer-term follow-up studies with further radiographic evaluation of the severity of glenoid erosion and the association with functional outcomes and failure risk.
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Garret J, Godenèche A, Boileau P, Molé D, Etzner M, Favard L, Lévigne C, Sirveaux F, Walch G. Midterm results of pyrocarbon interposition shoulder arthroplasty: good outcomes after posttraumatic osteonecrosis without malunion of the tuberosities. JSES Int 2022; 6:787-794. [PMID: 36081691 PMCID: PMC9446222 DOI: 10.1016/j.jseint.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In vitro data demonstrate the potential benefits of the pyrocarbon as a bearing material against cartilage or bone. And pyrocarbon-free interposition arthroplasty has been used with positive outcomes for over 10 years for hand and wrist joint replacements. This study reports the midterm results of a Pyrocarbon Interposition Shoulder Arthroplasty (PISA) in primary and secondary glenohumeral osteoarthritis and in avascular osteonecrosis. Methods This prospective noncontrolled, multicenter study included 67 consecutive patients who underwent PISA in France and Sweden. Results A cohort of 48 patients, aged 50 ± 12 years, was available for clinical assessment at a mean follow-up of 67.6 ± 9.3 months. A favorable change was reported with a mean absolute Constant score improvement of 32 ± 20 points. The highest Constant score improvement was observed in patients with avascular osteonecrosis (42 ± 18 points; P ≤ .0001). Between the earliest and the latest follow-up, radiographic analyses revealed only 2 major glenoid erosions and 4 tuberosity thinnings and thus that 86.4% of 44 shoulders remained stable with no or minor radiologic evolutions. The survival rate was 84 % at 65 months of follow-up considering all causes of revision. Conclusion The radiographic findings seem to confirm the interest of pyrocarbon in preserving bony surfaces. But the risk of tuberosity thinning suggests considering the use of PISA with caution in most degenerative glenohumeral joint pathologies, although the midterm outcomes highlight PISA as a suitable solution for patients presenting with posttraumatic osteonecrosis without malunion of the tuberosities and with an intact rotator cuff.
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Cointat C, Raynier JL, Vasseur H, Lareyre F, Raffort J, Gauci MO, Boileau P. Short-term outcomes and survival of pyrocarbon hemiarthroplasty in the young arthritic shoulder. J Shoulder Elbow Surg 2022; 31:113-122. [PMID: 34280573 DOI: 10.1016/j.jse.2021.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose was to report the short-term outcomes and survival of hemiarthroplasty with a pyrocarbon head (HA-PYC) for the treatment of shoulder osteoarthritis in patients aged ≤ 60 years. We hypothesized that HA-PYC could be an alternative to hemi-metal (avoiding the risk of rapid glenoid erosion) and total shoulder arthroplasty (TSA) (avoiding the risk of rapid glenoid loosening) in an active patient population. METHODS Sixty-four consecutive patients (mean age, 53 years) who underwent HA-PYC for glenohumeral osteoarthritis were included. The primary outcome was revision to TSA or reverse shoulder arthroplasty. Secondary outcome measures included functional outcome scores; return to work and sports; and radiographic evaluation of humeral reconstruction quality using the "circle method" of Mears, as well as glenoid erosion severity and progression using the Sperling classification. Patients were reviewed and underwent radiography at an average follow-up of 33 months (range, 24-60 months). RESULTS At last follow-up, the rate of survival of the HA-PYC prosthesis was 92%. Revision was performed in 5 patients, with a mean delay of 24 months (range, 15-37 months): 1 conversion to TSA and 4 conversions to reverse shoulder arthroplasty. The Constant score and Subjective Shoulder Value increased from 36 points (range, 26-50 points) to 75 points (range, 69-81 points) and from 35% (range, 20%-50%) to 80% (range, 75%-90%), respectively (P < .001). Postoperatively, 91% of the patients (42 of 46) returned to work and 88% (15 of 17) returned to sport. The severity of preoperative and postoperative glenoid wear (Sperling grade 3 or 4) had no influence on the functional results. Patients who underwent associated concentric glenoid reaming (n = 23) had similar Constant scores and Subjective Shoulder Values (P = .95) to other patients and did not show more progression of glenoid wear. Nonanatomic reconstruction of the proximal humerus (center of rotation of the prosthesis > 3 mm from the anatomic center) occurred in 29% (18 of 62 patients) and was associated with significantly lower functional and subjective results, more complications (subscapularis insufficiency and/or symptomatic glenoid erosion), and a higher risk of revision. The additional 1.5-mm thickness of the metal disc under the pyrocarbon head was found to be the main reason for oversizing of the prosthetic head. CONCLUSION HA-PYC is a reliable procedure to treat shoulder osteoarthritis and allows return to work and sports in a young (≤60 years) and active patient population. The severity of glenoid bone erosion or the association with glenoid reaming does not affect functional outcomes and failure risk. By contrast, nonanatomic reconstruction of the proximal humerus after HA-PYC (because of humeral head oversizing) occurred in one-third of the cases and is associated with lower functional outcomes, as well as higher risks of complications and revision.
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Affiliation(s)
- Caroline Cointat
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | - Jean Luc Raynier
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | | | | | | | - Marc Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
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Pyrocarbon unipolar radial head prosthesis: clinical and radiologic outcomes at long-term follow-up. J Shoulder Elbow Surg 2021; 30:2886-2894. [PMID: 34175466 DOI: 10.1016/j.jse.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies have already reported good short-term results with a pyrocarbon unipolar radial head prosthesis (Pyc-uRHP). The aim was to evaluate the evolution from mid- to long-term clinical and radiographic outcomes of a Pyc-uRHP. METHODS This was a retrospective, single-center study. We followed up all the patients who underwent Pyc-uRHP surgery in our original study at 2 years of follow-up (52 patients), reaching a minimum of 7 years of clinical and radiologic follow-up. This study included 26 patients who underwent a clinical examination assessing mobility, the Mayo Elbow Performance Score, and the visual analog scale score and radiologic evaluation with anteroposterior and profile radiographs at a mean follow-up of 110 months (range, 78-162 months). The radiologic study analyzed signs of proximal osteolysis, stem loosening, capitellar wear, and humeroulnar osteoarthritis. RESULTS No patients required revision. Eight patients required reoperation: coronoid screw removal in 1 and arthrolysis for stiffness in 7. The mean time to reoperation was 11 months. The mean Mayo Elbow Performance Score at last follow-up was 96 ± 9 (of 100), with a pain score of 42 ± 7 (of 45), mobility score of 19 ± 2 (of 20), stability score of 10 (of 10), and function score of 25 (of 25). Comparison with clinical data from the mid-term delay did not reveal any significant difference. All patients presented with proximal osteolysis around the neck but without progression. No stem loosening was noted. The rates of humeroulnar osteoarthritis (12% at mid-term vs. 80% at last follow-up, P < .0001) and capitellar lesions (34% at mid-term vs. 80% at last follow-up, P = .001) increased significantly. CONCLUSION We have shown that a Pyc-uRHP at 9 years' follow-up provided stable and satisfactory clinical results. Osteolysis of the radial neck was always present but it did not evolve, and no stem loosening was noted. Finally, we have shown a clear worsening of radiologic humeroulnar osteoarthritis and capitellar lesions that remained asymptomatic.
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Hirakawa Y, Ode GE, Le Coz P, Onishi S, Baverel L, Ferrand M, Collin P. Poor results after pyrocarbon interpositional shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2361-2369. [PMID: 33677116 DOI: 10.1016/j.jse.2021.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Gabriella E Ode
- Department of Orthapaedics, Prisma Health-Upstate, Greenville, SC, USA
| | - Pierre Le Coz
- Service de Chirurgie Orthopédique, réparatrice et traumatologique du CHU Pontchaillou de Rennes, Rennes, France; Institut Locomoteur de l'Ouest, CHP St Grégoire, St Grégoire, France
| | - Shinzo Onishi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Laurent Baverel
- Institut Locomoteur de l'Ouest, CHP St Grégoire, St Grégoire, France
| | - Mathieu Ferrand
- Institut Locomoteur de l'Ouest, CHP St Grégoire, St Grégoire, France
| | - Philippe Collin
- Institut Locomoteur de l'Ouest, CHP St Grégoire, St Grégoire, France.
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Pyrocarbon Humeral Head in a Shoulder Hemiarthroplasty: Preliminary Results at 3 Years Follow-Up and Review of the Current Literature. Case Rep Orthop 2021; 2021:6633690. [PMID: 33954000 PMCID: PMC8060089 DOI: 10.1155/2021/6633690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
Shoulder hemiarthroplasty is a viable option in young patients with an intact rotator cuff in order to preserve the native glenoid. To avoid the dreaded and expected wear of the glenoid in very active shoulders, implants with humeral head coated with a high resistant and elastic material—pyrolytic carbon—are now an option. The authors present the first pyrocarbon coated hemishoulder arthroplasty performed at our Orthopedic Department in a patient with osteonecrosis of the humeral head. At three years of follow-up, the patient is pain free and without limitations in his daily work. The Constant score was applied pre- and postoperatively, and an improvement of 32 points was reported. Larger cohorts with long-term follow-up are required to confirm our promising results.
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Boileau P, Galvin JW, Pangaud C, Gonzalez JF, Gauci MO. Response to Letter to the Editor regarding: "Fracture of pyrocarbon humeral head resurfacing implant: a case report". J Shoulder Elbow Surg 2021; 30:e134-e135. [PMID: 33359906 DOI: 10.1016/j.jse.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice - ICR - Institute for Reconstructive Bone and Joint Surgery & Sport Surgery, 7 av Durante, Nice, France.
| | - Joseph W Galvin
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
| | - Corentin Pangaud
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France.
| | - Jean-François Gonzalez
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
| | - Marc-Olivier Gauci
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
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One complication doesn't prove bad results: Letter to the Editor regarding Pangaud et al: "Fracture of pyrocarbon humeral head resurfacing implant: a case report". J Shoulder Elbow Surg 2021; 30:e132-e133. [PMID: 33359905 DOI: 10.1016/j.jse.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
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Fracture of pyrocarbon humeral head resurfacing implant: a case report. J Shoulder Elbow Surg 2020; 29:e306-e312. [PMID: 32713470 DOI: 10.1016/j.jse.2020.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023]
Abstract
We report a case of a pyrocarbon humeral head resurfacing implant fracture, occurring 6 years after its implantation, without any obvious trauma or dislocation. Initial radiographs showed a proud and oversized pyrocarbon resurfacing implant. On clinical examination, the patient had a painful and pseudoparalyzed shoulder with subscapularis insufficiency. Imaging studies confirmed implant fracture and severe fatty infiltration (Goutallier, grade 4) of the subscapularis muscle. Intraoperatively, the implant was found to be fractured with multiple pyrocarbon debris in the glenohumeral joint. The implant was loose, and gross inspection showed no visible bony adhesion or ongrowth. Histologic analysis showed multiple seats of metallosis in the synovial tissue and cancellous bone of the humeral head. Successful management of this complication was managed with a thorough débridement and irrigation and revision to reverse shoulder arthroplasty. Our observation put into question the use of pyrocarbon as a humeral head resurfacing implant. The material seems to be too fragile to be used as a resurfacing implant and cannot achieve fixation of the implant to bone.
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