Pyrocarbon in shoulder arthroplasty: a narrative review of material properties and summary of clinical outcomes

Shoulder arthroplasty has seen an exponential increase in the number of procedures performed in the last decade, with numerous implants being introduced into the market. However, the goal of joint preservation remains a major challenge, especially in younger patients where a total joint replacement may be detrimental due to long-term complications. Pyrocarbon was introduced in the shoulder as an alternative to total joint replacement and metallic hemiarthroplasty. Pyrocarbon is a form of carbon which is produced through the pyrolysis of hydrocarbon gases at high temperatures in the absence of oxygen, which results in a material characterized by its isotropy, biocompatibility and low friction properties. It was first used in the human body in mechanical heart valves and then was introduced in orthopaedics to treat various conditions of the hand and wrist. The proposed advantages of pyrocarbon lie in its property of wear resistance and reduced erosion when it is in direct contact with bone and cartilage by virtue of its similar modulus of elasticity to cortical bone. A detailed literature search was carried out to identify the relevant literature available on this topic. In this review, we explore the current state of research and clinical applications of pyrocarbon in shoulder arthroplasty, delving into its mechanical properties, biocompatibility and associated clinical outcomes.