Systematic review and meta-analysis of 12 studies (536 patients) on pyrocarbon hemiarthroplasty for shoulder arthritis, mostly in younger patients. Pyrocarbon was proposed to form a cartilage-like neo-membrane and reduce glenoid wear. The review asks whether that theoretical advantage translates into good clinical and radiographic outcomes at minimum 2-year follow-up.
When you counsel a young patient (mean age ~54) with end-stage glenohumeral arthritis and preserved glenoid bone, hemiarthroplasty avoids the glenoid loosening and polyethylene wear that drives TSA revision (up to 50% at 10 years). Pyrocarbon was introduced on the theory that a cartilage-like neo-membrane would cut glenoid wear, backed by in vitro data showing far less wear than cobalt chromium.
The key teaching point: that theory did not hold up radiographically. Glenoid erosion still appeared in about 23% of patients, matching metal implants, and it was the top cause of both complications and revision.
A practical technical pearl: the pyrocarbon head is thicker than metal, so oversizing or leaving it proud creates a nonanatomic reconstruction and was tied to rotator cuff failure. Downsize accordingly. Weight the evidence carefully. All 12 studies are Level III-IV with follow-up under 5 years, so encouraging short-term Constant scores are overshadowed by unknown long-term survivorship.
Systematic review and meta-analysis of 12 studies (536 patients) on pyrocarbon hemiarthroplasty for shoulder arthritis, mostly in younger patients. Pyrocarbon was proposed to form a cartilage-like neo-membrane and reduce glenoid wear. The review asks whether that theoretical advantage translates into good clinical and radiographic outcomes at minimum 2-year follow-up.
When you counsel a young patient (mean age ~54) with end-stage glenohumeral arthritis and preserved glenoid bone, hemiarthroplasty avoids the glenoid loosening and polyethylene wear that drives TSA revision (up to 50% at 10 years). Pyrocarbon was introduced on the theory that a cartilage-like neo-membrane would cut glenoid wear, backed by in vitro data showing far less wear than cobalt chromium.
The key teaching point: that theory did not hold up radiographically. Glenoid erosion still appeared in about 23% of patients, matching metal implants, and it was the top cause of both complications and revision.
A practical technical pearl: the pyrocarbon head is thicker than metal, so oversizing or leaving it proud creates a nonanatomic reconstruction and was tied to rotator cuff failure. Downsize accordingly. Weight the evidence carefully. All 12 studies are Level III-IV with follow-up under 5 years, so encouraging short-term Constant scores are overshadowed by unknown long-term survivorship.