Technical Brief

Investigation of Squeaking in Pyrolytic Carbon Proximal Interphalangeal Joint Implants

[+] Author and Article Information
Caleb Davis, Andrew R. Thoreson, Lawrence Berglund

Biomechanics & Tendon and Soft
Tissue Biology Laboratories,
Division of Orthopedic Research,
Mayo Clinic,
Rochester, MN 55905

Steven L. Moran

Division of Plastic Surgery,
Mayo Clinic,
Rochester, MN 55905

Kai-Nan An

Biomechanics & Tendon and
Soft Tissue Biology Laboratories,
Division of Orthopedic Research,
Mayo Clinic,
Rochester, MN 55905

Peter C. Amadio

Biomechanics & Tendon and
Soft Tissue Biology Laboratories,
Division of Orthopedic Research,
Mayo Clinic,
Rochester, MN 55905
e-mail: pamadio@mayo.edu

lCorresponding author.

Manuscript received January 29, 2013; final manuscript received December 13, 2013; published online January 9, 2014. Assoc. Editor: Carl A. Nelson.

J. Med. Devices 8(1), 014508 (Jan 09, 2014) (5 pages) Paper No: MED-13-1015; doi: 10.1115/1.4026289 History: Received January 29, 2013; Revised December 13, 2013

One commonly reported complication of pyrolytic carbon arthroplasty at the proximal interphalangeal (PIP) joint is an annoying, painless, squeaking postoperatively. This squeak has been anecdotally associated with implant loosening or impending dislocation. The purpose of this study was to investigate the etiology of this squeaking. Proximal and distal components of the pyrolytic carbon PIP implant were inserted into foam bones and mounted onto an oscillating test device. We evaluated the effect of 96 combinations of load, velocity, contact angle, implant size, lubrication, and displacement amplitude over a total of 300 cycles for each condition. Sound analysis was performed on squeaking conditions. Fourteen conditions resulted in squeaking, all with a sound pattern similar to that noted clinically. Unlubricated, “dry” joints did not squeak. Squeaking most commonly occurred with fetal bovine serum lubrication, at higher loads, and at 0 deg hyperextension. Hyaluronic acid viscosupplementation stopped the squeaking in all cases.

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Fig. 1

The Ascension PyroCarbon PIP Total Joint replacement. The distal component is shown at the left, and the proximal component at the right in both (a) and (b).

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Fig. 2

Schematic of testing apparatus to reproduce sliding motion

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Fig. 3

Testing apparatus with vertical load stand in place

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Fig. 4

Approximate start (a) and end (b) points for PIP implant sliding during testing

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Fig. 5

Flow chart depicting order of test conditions for PIP joint implant simulation

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Fig. 6

Breakdown of conditions that produced PIP implant squeaking within 300 cycles of sliding motion

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Fig. 7

Power spectral density of squeaking observed (a) in vitro during sliding test, (b) and (c) recordings of two different patients with squeaking PIP replacement



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