Pyrocarbon in Metacarpophalangeal Arthroplasty: A Longitudinal Analysis of 253 Cases

included infections (n¼3), postoperative fractures (n¼4), heterotopic ossification (n¼5), and PIP dislocations (n¼13). Female patients, those with a history of a MCP dislocation, and patients requiring methotrexate for their inflammatory arthritis had higher rates of dislocations (P < 0.04). In those patients who did not undergo revision surgery, at a mean follow-up of 4.8 years, patients had significant improvements in their preoperative to postoperative pain levels (P < 0.01), as well as MCP arc of motion from 38o to 45o (P ¼ 0.002), as well as improvements in their pinch strengths (P < 0.001). Summary Points:
MCP arthroplasty using a pyrocarbon implant demonstrates nearly a 90% 5-year survival rate with a relatively low rate of complications.
Smokers and patients requiring methotrexate and prednisone had a higher revision surgery risk, while females and prior dislocations increased the rate of dislocations.
Overall, patients experienced predictable pain relief and improvements in their range of motion and pinch strength.

PAPER 78 Clinical Paper Session 14: Arthroplasty Saturday, September 12
4:03e4:10 PM Treatment, Surgical Technique, Basic Science, Prognosis/Outcomes, Hand and Wrist, Diseases and Disorders, General Principles

Pyrocarbon in Metacarpophalangeal Arthroplasty: A Longitudinal Analysis of 253 Cases Level 4 Evidence

Eric R. Wagner, MD John Weston, MD Matthew T. Houdek, MD Steven L. Moran, MD Marco Rizzo, MD Consulting Fee: Intregra (Moran) Hypothesis: The objective of this study was to examine a large prospective group of patients who underwent PIP arthroplasty utilizing a pyrocarbon prosthesis, attempting to identify those factors that have a significant influence on the outcomes. Methods: An analysis of 254 consecutive MCP arthroplasties in 110 patients was prospectively collected using an institution’s total joints registry over a 14 year time period from 1998 to 2012. Demographics included average age of 56 years, BMI 29.8 kg/m2, 65% females, 13% smokers, 11% with diabetes mellitus (DM), 4% laborers, and with 60% involving the dominant extremity. Diagnoses included inflammatory arthritis (n¼164), post-traumatic arthritis (n¼37), and osteoarthritis (n¼53). Of the 164 fingers with inflammatory arthritis, 51 required prednisone and 93 required methotrexate perioperatively. 32 implants were augmented with bone graft. Results: Of the 253 arthroplasties performed over the 14-year time-period (224 primaries, 30 revisions), 26 (10%) patients underwent revision surgery. Revision surgeries were performed for dislocations (n¼8), recurrent ulnar deviation or subluxation (n¼5), pain with limited motion (n¼12), and proximal component loosening (n¼1). The 2, 5 and 10-year survival rates were 96%, 89%, and 77%, respectively. The risk for revision surgery was increased in smokers (P < 0.05) and those with inflammatory arthritis requiring either prednisone or methotrexate (P < 0.02). Breaking down by indication, the 5-year survival for inflammatory arthritis (90%) (blue), osteoarthritis (85%) (red), and post-traumatic arthritis (85%) (red) were not significantly different. Intraoperative fractures and smokers also had an increased risk for revision surgery (Table 1). Sixteen operations were complicated by intraoperative fractures. Postoperative complications e54

PAPER 79 Clinical Paper Session 15: Pediatrics Saturday, September 12
3:35e3:42 PM Prognosis/Outcomes, Congenital and Pediatric Problems, Diseases and Disorders

Simple vs. Complex Syndactyly of the Hand: A Nationwide Comparison of Clinical Characteristics, Associated Congenital Anomalies, and Postoperative Outcomes in 528 Patients Level 2 Evidence

Grant M. Kleiber, MD Rajiv P. Parikh, MD