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Poor results after pyrocarbon interpositional shoulder arthroplasty.

Yoshihiro Hirakawa1, Gabriella E Ode2, Pierre Le Coz3

  • 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Journal of Shoulder and Elbow Surgery
|March 7, 2021
PubMed
Summary

Pyrocarbon interposition shoulder arthroplasty (PISA) showed a high failure rate in younger patients with Walch B osteoarthritis, often requiring revision surgery. Short-term outcomes were better for other indications, but long-term implant survival is uncertain.

Keywords:
Glenohumeral arthritisinterposition arthroplastypyrocarbonpyrolytic carbonshouldershoulder arthroplasty

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Area of Science:

  • Orthopedic surgery
  • Biomaterials science
  • Clinical outcomes research

Background:

  • Pyrocarbon interposition shoulder arthroplasty (PISA) is a surgical option for shoulder joint reconstruction.
  • Complications and long-term efficacy of PISA require further investigation, particularly in specific patient demographics.

Purpose of the Study:

  • To evaluate the clinical outcomes and complications associated with pyrocarbon interposition shoulder arthroplasty (PISA).
  • To assess the need for revision surgery and patient-reported outcomes following PISA.

Main Methods:

  • Retrospective review of 10 patients who underwent PISA using the InSpyre prosthesis.
  • Analysis of clinical and radiographic records, including patient-reported outcomes (Constant Score, Subjective Shoulder Value) and range of motion.
  • Surgical indications included Walch type B glenoid osteoarthritis, avascular necrosis, and secondary osteoarthritis with axillary nerve dysfunction.

Main Results:

  • Five of ten patients required revision surgery to reverse shoulder arthroplasty due to poor outcomes, all with baseline Walch B glenoid morphology.
  • The mean time to revision surgery for this subset was 60 months.
  • The remaining five patients demonstrated significant short-term improvements in Constant Score and Subjective Shoulder Value at a mean follow-up of 35 months.

Conclusions:

  • PISA demonstrated a high clinical failure rate and poor long-term results in younger patients with Walch B glenohumeral osteoarthritis.
  • Caution is advised against using PISA in this specific patient population.
  • PISA showed more favorable short-term outcomes for humeral-sided deformities or severe secondary osteoarthritis with axillary nerve dysfunction, though longevity remains unclear.