Health Problem: Patients with osteoarthritis (OA), rheumatoid arthritis (RA), traumatic injury, or systemic lupus erythematosus (SLE) may experience dysfunction in joints of the hand and fingers, including the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. MCP joints are the key joints for finger function and allow for extension-flexion (straightening-bending), adduction-abduction (in-out), and some rotation. The interphalangeal (IP) joints are hinged with a functional stability throughout an arc of flexion and extension. Proper performance of the PIP and MCP joints is critical for overall hand functionality. If arthritis of the PIP and MCP joints becomes severe (i.e., with significant joint destruction and/or deformity) and can no longer be treated by conservative approaches, surgical options may be required.

Technology Description: Pyrocarbon PIP and MCP joint implants are 2-piece artificial finger joints, with 1 piece that consists of a ball-shaped end and a stem, and the other, a cup-shaped receptacle and a stem. Each of these pieces is made of a special form of carbon called pyrocarbon that encases a graphite substrate material. During surgery, the stems of each piece are implanted into the shafts of the finger bones without bone cement; the finger bones and surrounding soft tissues (e.g., muscles, tendons, ligaments) make the joint stable. Postoperative therapy regimens share the common aims of encouraging joint flexion and extension.

Controversy:  It is unclear whether pyrocarbon implants are associated with equivalent or superior outcomes compared with silicone or metal-on-plastic implants for PIP or MCP joint arthroplasty. Further, there is concern that pyrocarbon implants may be associated with higher complication rates.

Key Questions:

  • How do pyrocarbon joint implants for arthroplasty of PIP and MCP joints compare with alternative procedures for improving pain, range of motion, function, and strength?
  • How do pyrocarbon joint implants for arthroplasty of PIP and MCP joints compare with alternative procedures with regard to safety and adverse events?
  • Have definitive patient selection criteria been established for pyrocarbon PIP and MCP joint implants?

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