Erfolge in der Endoprothetik: Versorgung der Fingergelenke

Zusammenfassung

Die Endoprothetik der Fingergelenke kann nicht als Erfolgsgeschichte eingestuft werden. Endoprothesenerfordende Fingergelenkdestruk­tionen sind überwiegend rheumatisch bedingt. Rheumatisch destruierte Fingergelenke sind großen exzentrisch wirken Kräften ausgesetzt, die durch den krankheitsbedingten Fehlverlauf der gelenkübergreifenden Sehnen bedingt sind. Eine kräfterezentriernde Zwangsführung über Prothesen führt daher zwangsweise zu einem Bruch oder Ausbruch des Implantates. Verlässliche Rekonstruktionstechniken der periartikulären Strukturen zur Rezentierung der kraftführenden Beugesehnen sind bis heute nicht etabliert werden. Teilgekoppelte Prothesen gelangen daher an ihren Anschlag und verhalten sich wie gekoppelte Prothesen. Ungekoppelte Prothesen sind nur in frühen Stadien sinnvoll und zeigen gehäuft Luxationen. Die von Swanson vor etwa 50 Jahren inaugurierte Stabilisierung einer Resektionsarthroplastik durch ein Silikonimplantat umgeht die Problematik der implantatgeführten Kraftübertragung. Das Implantat ermöglicht durch Ausrichtung der periimplantären Vernarbung eine Korrektur der rheumatypischen Fehlstellungen. Die Silikonarthroplastik darf daher weiterhin als Goldstandard gelten, obwohl neuere Modifikationen des Silikonspacers tendenziell eine Verbesserung der eingeschränkten postoperativen Beweglichkeit ermöglichen.

Abstract

The history of joint replacement is far from being a success story. The main cause of destruction in finger joints is rheumatoid arthritis. The excentic displacement of tendons in rheumatoid hands generates high deviating loads on the destroyed joints. Recentration of the deviating forces by constrained endoprotheses is frequently followed by fracture or loosening of the implants. As long as reliable repair of the periarticular structures with recentration of the force transmitting flexor tendons is not possible, unconstrained endoprostheses tend to luxate and semiconstrained implants will act similarly to constrained replacements. Silicone arthroplasty, which was developed by Swanson about 50 years ago, avoids these problems. Scar formation around the silicone implant, called an encapsulation process, corrects joint deviations and allows a limited range of motion. Silicone arthroplasty is still the golden standard in finger joint arthroplasty. New modifications of the silicone implants afford slightly better ROM values.

Schlüsselwörter

Rheuma - Handchirurgie - Arthroplastik

Key words

rheumatoid arthritis - hand surgery - arthroplasty

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