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Pyrocarbon interposition arthroplasty

8 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Pyrocarbon interpositional arthroplasty provides pain relief and high patient satisfaction with good implant longevity at minimum 8-year follow-up [1]. The PyroDisk interposition has merit in patients with early trapeziometacarpal osteoarthritis unresponsive to conservative measures, in whom trapeziectomy may be considered too destructive and hemi or total arthroplasty overzealous [2]. Partial trapeziectomy with pyrocarbon arthroplasty provides excellent pain relief and high patient satisfaction at minimum 2-year follow-up [3].

The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure improves functional results by increasing active and passive range of movement at the trapeziometacarpal joint [4]. The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure provides joint stability [4]. The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure provides pain relief comparable to standard techniques [4]. The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure preserves thumb length [4]. The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure preserves key pinch strength [4].

The PyroDisk implant for treating advanced trapeziometacarpal arthritis did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition at minimum 5-year follow-up [5]. Subjective outcomes following ligament reconstruction and tendon interposition (LRTI) and pyrolytic interpositional arthroplasty are similar in patients with trapeziometacarpal osteoarthritis [6]. Objective outcomes following ligament reconstruction and tendon interposition (LRTI) and pyrolytic interpositional arthroplasty are similar in patients with trapeziometacarpal osteoarthritis [6]. Pinch strength is more improved following pyrolytic interpositional arthroplasty compared to ligament reconstruction and tendon interposition in patients with trapeziometacarpal osteoarthritis [6].

The Pyrocardan implant may be contraindicated in patients with symptomatic scaphotrapeziotrapezoid joint osteoarthritis who intend to continue high-load activities [7]. The Pyrocardan implant may be contraindicated in patients with symptomatic scaphotrapeziotrapezoid joint osteoarthritis who engage in activities involving wrist extension under load, such as tennis [7].

Anatomy & Pathophysiology

Indications and Contraindications

Pyrocarbon interpositional arthroplasty is indicated for trapeziometacarpal (TMC) joint osteoarthritis [1, 3, 5]. The PyroDisk interposition is considered for patients with early TMC disease unresponsive to conservative measures [2]. This procedure is considered less destructive than trapeziectomy for early disease [2] and less overzealous than hemi or total arthroplasty for early disease [2].

Conversely, pyrocarbon interpositional arthroplasty may be contraindicated in patients with symptomatic scaphotrapeziotrapezoid (STT) osteoarthritis who intend to continue high-load activities [7]. It may also be contraindicated in patients with symptomatic STT osteoarthritis who perform activities involving wrist extension under load, such as tennis [7].

Clinical Outcomes

Pyrocarbon interpositional arthroplasty provides pain relief in patients with TMC osteoarthritis [1, 3, 4]. The procedure provides high patient satisfaction in patients with TMC osteoarthritis [1, 3] and demonstrates good implant longevity [1].

Regarding comparative outcomes, PyroDisk implant treatment for advanced TMC arthritis did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition [5]. However, pyrolytic interpositional arthroplasty results in improved pinch strength compared to ligament reconstruction and tendon interposition (LRTI) [6]. Subjective outcomes following LRTI and pyrolytic interpositional arthroplasty are similar [6]. Objective outcomes following LRTI and pyrolytic interpositional arthroplasty are similar, excluding pinch strength [6].

Biomechanical and Functional Effects

The modified partial trapeziectomy with pyrocarbon arthroplasty increases active range of movement at the TMCJ [4]. The procedure increases passive range of movement at the TMCJ [4]. Furthermore, the modified partial trapeziectomy with pyrocarbon arthroplasty provides joint stability [4]. The technique preserves thumb length [4] and preserves key pinch strength [4].

Classification

Pyrocarbon Interpositional Arthroplasty: This technique is indicated for patients with Eaton and Littler grade 2 or 3 trapeziometacarpal osteoarthritis who remain unresponsive to conservative measures [2, 8]. It is specifically considered for patients in whom trapeziectomy may be too destructive and hemi or total arthroplasty overzealous [2]. The procedure provides pain relief comparable to standard techniques, excellent pain relief, and high patient satisfaction [1, 3, 4]. It improves functional results by increasing active and passive range of movement at the trapeziometacarpal joint while providing joint stability, preserving thumb length, and preserving key pinch strength [4]. Furthermore, it preserves height, stability, strength, and movement after surgery [8] and demonstrates good implant longevity [1]. However, it is not superior to published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition for advanced trapeziometacarpal arthritis [5].

Comparative Outcomes vs. LRTI: Subjective and objective outcomes following pyrolytic interpositional arthroplasty are similar to those following ligament reconstruction and tendon interposition (LRTI), except for pinch strength [6]. Pinch strength is more improved following pyrolytic interpositional arthroplasty than following LRTI [6].

Implant-Specific Considerations: The PyroDisk implant has an 8.4% removal rate due to ongoing problems after operation [8]. The Pyrocardan implant is contraindicated in patients with symptomatic scaphotrapeziotrapezoid joint osteoarthritis who intend to continue high-load activities, particularly those involving wrist extension under load such as tennis [7].

Clinical Presentation

Pyrocarbon interpositional arthroplasty is indicated for trapeziometacarpal osteoarthritis [1, 3]. The pyrocarbon disc implant is designed for the surgical treatment of CMC thumb joint osteoarthritis [8] and is specifically indicated for Eaton and Littler grade 2 or 3 osteoarthritis [8]. The PyroDisk implant is used for treating advanced trapeziometacarpal arthritis [5].

Indication Criteria: * Early Disease: PyroDisk interposition is considered for patients with early disease unresponsive to conservative measures [2]. * Alternative to Trapeziectomy: PyroDisk interposition is considered when trapeziectomy may be too destructive [2]. * Alternative to Arthroplasty: PyroDisk interposition is considered when hemi or total arthroplasty is overzealous [2].

Clinical Outcomes: Pyrocarbon interpositional arthroplasty provides pain relief [1] and high patient satisfaction [1]. Partial trapeziectomy with pyrocarbon arthroplasty provides excellent pain relief [3] and high patient satisfaction [3]. Pyrolytic interpositional arthroplasty improves pinch strength more than LRTI [6].

Modified Procedure Benefits: The modified procedure provides joint stability [4]. The modified procedure provides pain relief comparable to standard techniques [4]. The modified procedure preserves thumb length [4]. The modified procedure preserves key pinch strength [4].

Investigations

Plain radiography: Pyrocarbon interpositional arthroplasty provides pain relief [1] and results in high patient satisfaction [1] for trapeziometacarpal osteoarthritis. The procedure demonstrates good implant longevity with a minimum 8-year follow-up [1]. Partial trapeziectomy with pyrocarbon arthroplasty provides excellent pain relief [3] and results in high patient satisfaction [3] for trapeziometacarpal joint osteoarthritis. The modified partial trapeziectomy and pyrocarbon interpositional arthroplasty procedure improves functional results by increasing active range of movement at the TMCJ [4] and increases passive range of movement at the TMCJ [4].

Other Considerations: PyroDisk interposition is indicated for patients with early trapeziometacarpal disease unresponsive to conservative measures [2]. It is considered when trapeziectomy is viewed as too destructive and hemi or total arthroplasty as overzealous [2]. The PyroDisk implant for advanced trapeziometacarpal arthritis did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition [5]. Subjective outcomes are similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis [6]. Objective outcomes are similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis [6]. Pinch strength is more improved following pyrolytic interpositional arthroplasty compared to LRTI in patients with TMC arthritis [6]. The Pyrocardan implant may be contraindicated in patients with symptomatic STT OA who intend to continue high-load activities [7]. The Pyrocardan implant may be contraindicated in patients with symptomatic STT OA who engage in activities involving wrist extension under load, such as tennis [7].

Treatment

Non-Operative

PyroDisk interposition is indicated for patients with early trapeziometacarpal osteoarthritis who remain symptomatic despite conservative management [2].

Operative

Indications: The procedure is appropriate for early trapeziometacarpal osteoarthritis unresponsive to conservative measures, particularly when trapeziectomy is deemed too destructive and hemi or total arthroplasty is considered overzealous [2].

Outcomes: Subjective outcomes are similar following ligament reconstruction and tendon interposition (LRTI) and pyrolytic interpositional arthroplasty in patients with trapeziometacarpal osteoarthritis [6]. Objective outcomes are similarly comparable between these two surgical approaches [6].

Complications

Other Considerations: Pyrocarbon interpositional arthroplasty may be contraindicated in patients with symptomatic scaphotrapeziotrapezoid (STT) osteoarthritis who intend to continue high-load activities, particularly those involving wrist extension under load such as tennis [7].

Recovery

Pyrocarbon interpositional arthroplasty results in high patient satisfaction [1]. PyroDisk interposition is suitable for patients with early disease unresponsive to conservative measures [2]. PyroDisk interposition is considered when trapeziectomy is viewed as too destructive [2]. PyroDisk interposition is considered when hemi or total arthroplasty is viewed as overzealous [2].

Light activity (weeks): Evidence does not specify a week range for light activity, desk work, driving, or light ADLs.

Full activity (months): Evidence does not specify a month range for manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): Partial trapeziectomy with pyrocarbon arthroplasty provides excellent pain relief with a minimum 2-year follow-up [3]. Partial trapeziectomy with pyrocarbon arthroplasty results in high patient satisfaction with a minimum 2-year follow-up [3]. The PyroDisk implant did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition at minimum 5-year follow-up [5].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: The modified partial trapeziectomy and pyrocarbon interpositional procedure improves functional results by increasing active range of movement at the TMCJ [4]. The modified partial trapeziectomy and pyrocarbon interpositional procedure improves functional results by increasing passive range of movement at the TMCJ [4]. The modified partial trapeziectomy and pyrocarbon interpositional procedure provides joint stability [4]. The modified partial trapeziectomy and pyrocarbon interpositional procedure provides pain relief comparable to standard techniques [4]. The modified partial trapeziectomy and pyrocarbon interpositional procedure preserves thumb length [4]. The modified partial trapeziectomy and pyrocarbon interpositional procedure preserves key pinch strength [4].

Other Considerations: Evidence does not specify validated PROM trajectories, outcome-measure benchmarks, predictors of return-to-work failure, or patient-selection caveats for early ROM.

Key Evidence

  • [L4] Pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction with good implant longevity. [1] (10.1177/1753193420906805)
  • [L4] PyroDisk interposition has merit in patients with early disease unresponsive to conservative measures, in whom trapeziectomy may be considered too destructive and hemi or total arthroplasty overzealous. [2] (10.1177/1753193420981552)
  • [L3] Partial trapeziectomy with pyrocarbon arthroplasty may prove to be a successful option for the treatment of trapeziometacarpal joint osteoarthritis, providing excellent pain relief and high patient satisfaction. [3] (10.1177/1753193413519384)
  • [L4] The modified procedure improves functional results by increasing active and passive range of movement at the TMCJ, providing joint stability and pain relief comparable to standard techniques, while preserving thumb length and key pinch strength. [4] (10.1177/1753193414553368)
  • [L4] The PyroDisk implant for treating advanced trapeziometacarpal arthritis did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition. [5] (10.1016/j.jhsa.2014.07.011)
  • [L3] All subjective and objective outcomes were similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis, except pinch strength, which was more improved following pyrolytic interpositional arthroplasty. [6] (10.1155/2019/7961507)
  • [Case_report] The Pyrocardan implant may be contraindicated in patients with symptomatic STT OA who intend to continue high-load activities, particularly those involving wrist extension under load, such as tennis. [7] (10.1016/j.jhsg.2026.100964)
  • [L4] [8] (10.1016/j.jhsa.2018.06.086)

See Also

References

[1] Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420906805

[2] Re: Smeraglia F, et al. Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up. J Hand Surg Eur. 2020, 45: 472–6. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193420981552

[3] Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193413519384

[4] Re: Mariconda et al. Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up. J Hand Surg Eur. 2014, 39: 604–610. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414553368

[5] Pyrocarbon Interposition (PyroDisk) Implant for Trapeziometacarpal Osteoarthritis: Minimum 5-Year Follow-Up. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.011

[6] Tendon versus Pyrocarbon Interpositional Arthroplasty in the Treatment of Trapeziometacarpal Osteoarthritis. BioMed Research International. 2019. DOI: 10.1155/2019/7961507

[7] Game, Set… Revision! A Case Report of a Tennis Player Who Smashed His Scaphotrapeziotrapezoid-Joint Pyrocardan Implant Twice. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100964

[8] Long-Term Follow-Up After Pyrocarbon Disc Interposition for Thumb CMC Osteoarthritis. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.086

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