Pyrocardan® Implant Arthroplasty or LRTI for Trapeziometacarpal Osteoarthritis

Pyrocardan® Implant Arthroplasty or LRTI for Trapeziometacarpal Osteoarthritis - A Randomized Controlled Trial

This is a randomized controlled trial comparing the Pyrocardan® implant (intervention group) with the standard ligament reconstruction and tendon interposition (LRTI) (control group). All Danish citizens with osteoarthritis of the thumb carpometacarpal joint referred to the orthopedic department at Copenhagen University Hospital in Herlev/Gentofte will be considered for participation in the trial. The following exclude from participation in the study: Below 40 years of age; cognitive or linguistic impairment; osteoarthritis of other carpal bones; previous surgery in the carpometacarpal joint; patients with rheumatoid arthritis. A total of 64 patients will be included. The primary outcome is the patient reported outcomes questionnaire; Quick-DASH. The secondary outcomes are patient-reported outcomes, functional outcomes, radiographic outcomes, readmission, complications, revisions. The patients are examined before surgery and 3, 6, 12 and 24 months after the operation. The patients are also contacted after 5 and 10 years.

Study Overview

• Status: Recruiting
• Conditions: Trapeziometacarpal Osteoarthritis; CMC-1 Osteoarthritis
• Intervention / Treatment: Procedure: Pyrocardan® implant; Procedure: Ligament reconstruction and tendon interposition (LRTI)

Detailed Description

The Pyrocardan® is designed by Philippe Bellemere and has been used since 2009. It is a biconcave-shaped CMC-1 interposition implant. The biconcave shape converts the CMC-1 saddle joint into a cardan-like joint. The implant is suitable for Eaton grade 2 or 3. The advantages compared to LRTI are believed to be preserved thumb length, faster recovery following surgery, increased grip and pinch strengths and less subsidence of the CMC-1 joint.

Most recently results from the Bellemere group in 2020 have shown excellent results in 103 patients 5 years following surgery. A study by Gerace et al. reported a significant improvement in pain, QuickDASH and strength, with a revision rate of 4% and a survival rate at 96% at 5 years of follow-up. A recent review from 2022 reported 97% survival rate at 4 years and an estimated survival rate of 95% at 7 years from surgery.

The purpose of this randomized study is to compare Pyrocardan® implant (intervention group 1.) with ligament reconstruction and tendon interposition (LRTI), (intervention group 2.) in patients treated with mild to moderate CMC-1 osteoarthritis. There is to our knowledge no randomized controlled trial (RCT) studies on Pyrocardan® implant.

Hypothesis Pyrocardan® can provide a faster recovery following surgery, increased grip and pinch strengths and less subsidence of the CMC-1 joint compared to LRTI.

All patients referred to the Orthopedic Surgery Department, Hand Surgery Unit at Copenhagen University Hospital in Herlev/Gentofte with CMC-1 OA with pain in the thumb base and suspected degenerative changes and indication of surgical treatment will be eligible for inclusion. The following criteria will result in exclusion from participation in the study: Age under 40, cognitive or linguistic impairment, presence of osteoarthritis in other carpal bones, previous surgery in trapeziometacarpal joint or diagnosis of rheumatoid arthritis.

A total of 64 patients will be included in the study based on a sample size calculation using the MCID of Q-DASH. This number will also account for a maximum dropout rate of 18%. The study will be a randomized clinical trial (RCT), where participants will be assigned to one of the two surgical techniques through a randomized process. Patients will be monitored to evaluate any differences between the techniques. The primary outcome measure will be the patient-reported outcome using the QuickDASH assessment. Secondary outcomes will include pain relief, questionnaires, radiographic changes, range of motion and strength (functional outcome), readmission rates, complications, and revisions. Patients will undergo examinations before the surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after the surgery. Additionally, patients will be contacted 5 and 10 years following the surgery for further follow-up. The study will be conducted as a single-center study and all procedures will be performed by one of three experienced hand surgeons.

• Study Type: Interventional
• Enrollment (Estimated): 64
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jens Jørgsholm, MD; Phone Number: +4551339705; Email: Jens.bertel.joergsholm.01@regionh.dk
• Study Contact Backup: Name: Rasmus Wejnold Jørgensen, MD, PhD; Phone Number: +4538673315; Email: rasmus.wejnold.joergensen@regionh.dk

Study Locations

• Denmark
  • Hellerup, Denmark, 2900
    • Recruiting
    • Herlev and Gentofte Hospital
    • Contact: Jens Jørgsholm, MD; Phone Number: +4551339705; Email: Jens.bertel.joergsholm.01@regionh.dk
    • Contact: Rasmus Wejnold Jørgensen, MD, PhD; Phone Number: +4538673315; Email: rasmus.wejnold.joergensen@regionh.dk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Osteoarthritis of the trapeziometacarpal joint of the thumb.
2. Insufficient effect of non-surgical treatment with symptoms severe enough to justify surgical treatment.
3. ASA score 1-3, physically fit for surgery and rehabilitation

Exclusion Criteria:

1. Below 40 years of age
2. Cognitive or linguistic impairment
3. Osteoarthritis in other carpal bones (STT OA and others)
4. Previous surgical treatment in the trapeziometacarpal joint.
5. Patients with rheumatoid arthritis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Pyrocardan® implant	Procedure: Pyrocardan® implant; Biconcave-shaped CMC-1 interposition implant
Active Comparator: Ligament reconstruction and tendon interposition (LRTI)	Procedure: Ligament reconstruction and tendon interposition (LRTI); Weilby slightly modified as described by Burton and Pellegrini

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-reported outcome: QuickDASH	Quick version of the Disability of the arm, shoulder and hand questionnaire (QuickDASH): 0-100 p, higher score = more disability	6 weeks, 3 months, 6 months, 1 year, 2 years, 5 years and 10 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-reported outcome	VAS (rest), VAS (activity), 0-10 p, higher score = more pain. Satisfaction scores: 1-5 p, higher score = more satisfied.	6 weeks, 3 months, 6 months, 1 year, 2 years, 5 years and 10 years
Strength measurements	Hand grip and Pinch (Kg)	6 weeks, 3 months, 6 months, 1 year, 2 years
Radiographs	Measured subsidence on radiographs	6 weeks
Return to occupation	Postoperative sick leave	1 year

Collaborators and Investigators

• Sponsor: Herlev and Gentofte Hospital
• Investigators: Principal Investigator: Jens Joergsholm, MD, Herlev Gentofte Hospital

Study record dates

Study Major Dates

• Study Start (Actual): September 26, 2022
• Primary Completion (Estimated): September 30, 2025
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: February 14, 2024
• First Submitted That Met QC Criteria: February 26, 2024
• First Posted (Estimated): March 4, 2024

Study Record Updates

• Last Update Posted (Estimated): March 4, 2024
• Last Update Submitted That Met QC Criteria: February 26, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Osteoarthritis; Joint Diseases; Hand Osteoarthritis; CMC-1; Pyrocardan; Trapeziometacarpal Osteoarthritis
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis
• Other Study ID Numbers: Pyrocardan® RCT

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No