Dr. Beckenbaugh pointed out that the success of ball-and-socket implants requires the capability to construct a stable soft tissue envelope to allow bony fixation by appositional bone growth. While these implants may be ideal for osteoarthritis, posttraumatic arthritis, and some rheumatoid patients, the old silicone or cemented implants may be preferred for rheumatoid patients with soft medullary tissue and thin cortical bone.
He said that the greatest potential problem with ball-and-socket design is subluxation and/or recurrent ulnar deviation, which can be prevented with careful surgical technique and postoperative care. The new devices require a longer postoperative immobilization (usually 3–4 weeks), compared with silicone arthroplasty, to allow soft tissue to heal and create stability before motion therapy is begun.
All of the protheses discussed by Dr. Berger and Dr. Beckenbaugh have received approval from the Food and Drug Administration for use in the United States and the CE Mark for approval in Europe.
Hand disabled by rheumatoid arthritis before use of PIP Pyrocarbon Implants.
Surgical placement of the PIP Pyrocarbon Implants enable hand flexion in same patient. Photos courtesy Dr. Robert D. Beckenbaugh