Pyrocarbon interposition arthroplasty (Amandys®) has been proposed as a motion-preserving salvage procedure for advanced wrist degeneration. However, its clinical outcomes, complication profile, and role within the contemporary wrist salvage algorithm remain incompletely defined. To systematically review the clinical outcomes, complications, and revision patterns associated with Amandys® pyrocarbon interposition wrist arthroplasty, without performing a direct comparative analysis with other wrist salvage procedures, and to clarify its role among current treatment options. A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases. The search term “Amandys” was used without additional filters. Clinical studies reporting outcomes of Amandys® wrist arthroplasty were included. Data extraction focused on study characteristics, clinical outcomes, complications, and revision procedures. Methodological quality was assessed using the Coleman Methodology Score. Ten clinical studies met the inclusion criteria, comprising a total of 224 wrists treated with Amandys® interposition arthroplasty. Pain reduction and improvement in patient-reported outcome measures were consistently reported across studies, with preservation of wrist range of motion. Complication rates were substantial, with approximately one fifth of wrists experiencing postoperative complications and nearly one fifth requiring reoperation. Most secondary procedures were related to early mechanical instability and consisted of technically oriented revisions rather than implant removal. Conversion to total wrist arthrodesis occurred less frequently. The overall methodological quality of the included studies was moderate. Amandys® pyrocarbon interposition arthroplasty provides clinical improvement and preserves wrist motion but is associated with a relevant and less predictable rate of complications and reoperations. When feasible, proximal row carpectomy remains the preferred motion-preserving procedure. Amandys® arthroplasty should be regarded as a highly selective salvage option, particularly in patients unsuitable for proximal row carpectomy–based solutions, with careful patient selection being essential to optimize outcomes.
Smeraglia et al. (Sun,) studied this question.