In the past, joint replacements for the fingers have been made of metal or silicone. But problems with these materials has led to the development of a pyrolytic carbon (pyrocarbon) implant. One of the designers of this implant is Dr. Robert D. Beckenbaugh from the Mayo Clinic in Rochester, Minnesota.
In this article, Dr. Beckenbaugh and Dr. Rizzo present the pros and cons of this new implant. Step-by-step surgical technique is outlined for use of the pyrocarbon implant in the proximal interphalangeal (PIP) joint.
The PIP joints are the middle joints of the fingers. Color photos of the main steps in the surgery are included. A video of the procedure is available on-line. Standard guidelines for therapy after surgery are also included.
Pyrocarbon implants can be used for osteoarthritis, rheumatoid arthritis, instability, and stiffness or deformity of the fingers. There are some conditions which prevent the use of this type of implant. For example, patients with infection or tendons that can’t be repaired are not good candidates for pyrocarbon PIP joint replacement.
During the operation, the bone and joint is prepared for an implant. A trial implant is put in place to get the best fit and alignment. Surgeons use fluoroscopy to make sure everything fits properly. Fluoroscopy is a type of X-ray imaging that allows the surgeon to see inside the body while doing the operation.
Once the size and placement of the trial implant are correct, then the final implant is inserted. The soft tissues cut open in order to do the surgery are repaired. The skin is closed with sutures. A padded dressing and plaster splint are applied to the finger.
The authors provide a table of guidelines for rehab from day four through the first three months. Splinting, exercises, and activities are discussed. A summary of tips and pitfalls for the surgeon to watch out for is also included.