Orthopedic

Bionic Knuckles made from Pyrocarbon

Bionic knuckles are now available for sufferers of arthtritis. The replacement knuckles are made from Pyrocarbon which is the same type of material used in the Space Shuttle and nuclear reactors.

Pyrocarbon is as tough as diamond and can be carved into excatly the right shape. It also has similar flexibility to bone and will not cause an allergic reaction and be rejected by the body. They are designed to last a life time and are virtually impossible to wear out.

The technological breakthrough will bring hope to thousands of arthritis sufferers. Patients’ knuckles can fail for all sorts of reasons - not just because of rheumatoid or osteoarthritis (wear and tear arthritis), but also due to infection or injury.

Rubber hinge joints have been used since the 70's to replace inflamed and deformed knuckles of rheumatoid arthritis patients. They don’t look like actual knuckles but they can very successfully correct the deformity and reduce the pain. However, they aren’t very robust and can crack and break in a few years.

Dr David Warwick is a consultant hand surgeon at Southampton University Hospital.

In the past eight years, they have been trying out this new pyrocarbon replacement, using joints which are anatomically correct and function just like real knuckles.

The procedure can be done by simply numbing the arm, but many patients prefer to be asleep.

Dr David Warwick describes the operation. First, I made an incision over the affected knuckle. I carefully split the tendon to expose the joint capsule, which is the layer that encloses the knuckle. I parted this and was now able to see the knuckle joint beneath, which was completely worn out. I then used a special instrument called a jig to cut away the two worn ends of the bones. I cut out oblong holes in the middle of the bones using a file called a reamer.

When I was sure that the holes were just the right size and depth, I inserted the prongs of one half of the artificial knuckle in each and tapped them lightly until they held firm. Now the two new ends of bone would smoothly slide against each other and recreate normal knuckle function. I made sure that the two edges of the knuckle were moving smoothly against each other without dislocating; I then closed the capsule again and repaired the tendon directly over the new knuckle. Finally I closed up the skin with a neat row of stitches.

Without complications, which can include infection, stiffness, and joint dislocation, the patients can go home the next day.Its a really effective operation and can make a huge difference to patients’ lives. This operation is available in some specialist NHS hand centres throughout the UK. Privately, it costs around £4,000.

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