JBJS - 2026-04-15 - Journal Article; Multicenter Study
Clinical Outcomes of Pyrocarbon Hemiarthroplasty: A Short-Term, Multicenter Study.
Hatzidakis AM, Garrigues GE, Mauter LA, de Gast A, Venegoni MR, Yang Y, Johnston PS
Topics
Key Takeaway
Pyrocarbon hemiarthroplasty achieved a Composite Clinical Success rate of 82.7% at mean 24.4 months, significantly outperforming a propensity-matched cobalt-chromium HA cohort at 66.8% (p<0.001).
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Summary
This IDE-protocol prospective multicenter study evaluated pyrocarbon hemiarthroplasty in 157 patients (mean age 52.4 years) across 18 sites, comparing outcomes against a propensity score-matched historical cobalt-chromium HA cohort using a Composite Clinical Success threshold of ≥17-point Constant score improvement without revision or device-related adverse event. At mean 24.4 months, all active ROM and PRO measures improved significantly in the pyrocarbon group. CCS was 82.7% for pyrocarbon versus 66.8% for cobalt-chromium HA (p<0.001), with only 3 revisions prior to 24 months.
Key Limitation
The historical cobalt-chromium comparator cohort, rather than a concurrent randomized control arm, introduces temporal and institutional confounding that propensity score subclassification cannot fully correct.
Original Abstract
BACKGROUND
Unacceptable pain relief after hemiarthroplasty (HA) has limited its utilization for shoulder replacement. The material properties of pyrolytic carbon-graphite composites may result in less abrasion compared with metal bearing surfaces, theoretically decreasing glenoid-sided pain and erosion. This prospective, single-arm, multicenter study was performed to evaluate the short-term clinical outcomes and implant survivorship of pyrocarbon HA.
METHODS
The enrollment of 157 patients occurred at 18 sites between December 2015 and April 2017 as part of an Investigational Device Exemption protocol. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, patient satisfaction, EuroQol-5 Dimensions (EQ-5D) score, and active range of motion were evaluated. A historical control cohort treated with cobalt-chromium HA was identified through a propensity score subclassification analysis. The pyrocarbon HA and cobalt-chromium HA cohorts were compared on the basis of a Composite Clinical Success (CCS) rate, defined as a ≥17-point change in the Constant score without revision or a device-related adverse event.
RESULTS
Of the 157 patients enrolled, 144 had short-term follow-up (mean, 24.4 ± 1.2 months), 10 were lost to follow-up, and 3 underwent revision prior to 24 months due to pain or low-grade infection. The mean patient age was 52.4 ± 10.9 years (range, 19 to 73 years). There were significant improvements in all active range-of-motion and patient-reported outcomes. The outcomes of the pyrocarbon HA cohort (n = 157) were compared with those of the cobalt-chromium HA group (n = 169) eligible for a minimum 24-month follow-up, in which multiple imputation was employed to address missing data. The CCS was 82.7% for the pyrocarbon HA group and 66.8% for the cobalt-chromium HA group (p < 0.001).
CONCLUSIONS
Pyrocarbon HA demonstrated favorable results at a short-term follow-up and improved outcomes compared with the propensity score subclassification-derived cobalt-chromium HA cohort.
LEVEL OF EVIDENCE
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.