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• W4240716217 abstract "In January 2006 Daecke et al1Daecke W. Veyel K. Wieloch P. Jung M. Lorenz H. Martini A.K. Osseointegration and mechanical stability of pyrocarbon and titanium hand implants in a load-bearing in vivo model for small joint arthroplasty.J Hand Surg. 2006; 31A: 90-97Abstract Full Text Full Text PDF Scopus (61) Google Scholar reported on the failure of pyrocarbon proximal interphalangeal (PIP) implant osseointegration of a proximal phalanx hemiarthroplasty component compared with a titanium-stemmed similar design that became osseointegrated in a rabbit knee model. At the end of the article the authors suggested that Ti implants enable reliable osseointegration and the authors “recommend the use of Ti-based implants.” They further stated that the results from their study are relevant because of the increasing number of pyrocarbon implants being inserted into human beings. I would like to compliment the authors on their efforts to provide information on this subject but would purport that they have a misunderstanding of the principles of achieving implant stability with pyrocarbon. Pyrocarbon implants have no mechanical or chemical fixation to bone. They are stabilized by insertion into the medullary canals with computer-assisted designed stems to achieve initial mechanical stability (press-fit), followed by appositional bone growth that constantly remodels according to Wolfe’s law. Final implant fixation stabilization generally occurs at 6 to 24 months after surgery. In the study by Daecke et al1Daecke W. Veyel K. Wieloch P. Jung M. Lorenz H. Martini A.K. Osseointegration and mechanical stability of pyrocarbon and titanium hand implants in a load-bearing in vivo model for small joint arthroplasty.J Hand Surg. 2006; 31A: 90-97Abstract Full Text Full Text PDF Scopus (61) Google Scholar the pyrocarbon implants were inserted into the large medullary canals of a rabbit knee from the intended straight longitudinal orientation in the proximal phalanx. This results in the complete absence of the required anatomic support for pyrocarbon implants. In clinical use in human finger implants the angulation of the prosthetic interfaces in hyperextension, as present in this model, cause loosening and shift the prosthesis position. The angle of insertion of the prosthesis in the rabbit knee will subject the implant to these abnormal forces and shifting and loosening of the pyrocarbon prosthesis would be expected. The authors also tested the osseointegration of pyrocarbon and titanium porous stems by pull-out resistance at 3 months and stated that 9 of 9 titanium implants were stable on pull-out testing as expected because of the known bony osseointegration of titanium implants. This is an expected phenomenon with proven ingrowth of bone with a porous titanium stem. Daecke et al1Daecke W. Veyel K. Wieloch P. Jung M. Lorenz H. Martini A.K. Osseointegration and mechanical stability of pyrocarbon and titanium hand implants in a load-bearing in vivo model for small joint arthroplasty.J Hand Surg. 2006; 31A: 90-97Abstract Full Text Full Text PDF Scopus (61) Google Scholar noted that all pyrocarbon implants could be removed by finger pull-out at 3 months after insertion and stated that therefore there was no osseointegration. The authors clearly do not understand that this is an expected result with pyrocarbon. After initial insertion, appositional bone growth occurs around the prosthetic stems when stabilized mechanically by the surrounding cortical bones. There is no mechanical or chemical bond to the material to produce osseointegration. The authors’ failure to recognize this has brought them to a faulty conclusion with regard to implant stability in human PIP joints, which has been shown to occur by other investigators (see later). Munshi et al reported no loosening in 30 PIP pyrocarbon joint replacements for various diagnoses with a 24-month follow-up period (Presented at the BSSH/ASSHG combined meeting, 2003). Mrkongic et al reported no loosening in 13 patients with osteoarthritis and PIP pyrocarbon implants with more than 18 months of follow-up evaluation (Presented at the EFSSH, 2005). Hussain et al reported on 8 pyrocarbon PIP joint hemiarthroplasties for trauma with 3 to 23 months of follow-up evaluation (Presented at the IFSSH, 2004). Six percent of prosthesis loosened. In February 2006, we reported on 50 PIP joint replacements with 27 to 40 months of follow-up evaluation for various diagnoses. In August of 1983 Cook et al2Cook S. Beckenbaugh R.D. Weinstein A.M. Klawitter J. Pyrolite-carbon implants in the metacarpophalangeal joint of baboons.Orthopedics. 1983; 6: 952-981Crossref PubMed Google Scholar reported on the fixation findings after pyrolytic carbon metacarpophalangeal implants were placed in the finger joints of baboons. In this more anatomic model, bone fixation of pyrocarbon implants by appositional bone formation was clearly shown. In addition, Johnston (Presented at AAHS, 2005) reported on 22 titanium noncemented PIP implants with 6 to 34 months of follow-up evaluation: loosening occurred in 10 of 22 patients. He concluded that in human PIP joints, osseointegration of titanium-stemmed implants fails and he recommended cement fixation of titanium implants in human PIP joints. Clearly, the conclusion of the authors on the treatment of PIP arthritis based on a flawed study model and misunderstanding of the biological fixation of pyrocarbon is incorrect. Their study has no clinical relevance. The selection of an implant type for use in PIP joint replacement should be based on multiple factors including wear, strength, friction, durability, bone adaptability, and general biocompatibility. Both implants are appropriate and successful in multiple uses. Implant choice should not be based on this rabbit-knee hemiarthroplasty 3-month follow-up study, but rather on the earlier outlined factors and earlier-cited studies that favor the use of pyrocarbon. Osseointegration and Mechanical Stability of Pyrocarbon and Titanium Hand Implants in a Load-Bearing In Vivo Model for Small Joint ArthroplastyJournal of Hand SurgeryVol. 31Issue 1PreviewTo test the mechanical stability and histologic osseointegration under load-bearing conditions of 2 different materials, pyrocarbon (Py) and titanium (Ti), in a rabbit model. Full-Text PDF Implant StabilityJournal of Hand SurgeryVol. 31Issue 7PreviewIt is an honor for us that our experimental study on osseointegration and mechanical stability in small joint arthroplasty has aroused the interest of such notable hand surgeons and researchers as Drs. Beckenbaugh, Klawitter, and Cook. Full-Text PDF" @default.
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• W4240716217 title "Osseointegration and Mechanical Stability of Pyrocarbon and Titanium Hand Implants in a Load-Bearing In Vivo Model for Small Joint Arthroplasty" @default.
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