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Aktuelle Rheumatologie 2014; 39(02): 106-113
DOI: 10.1055/s-0033-1357147
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© Georg Thieme Verlag KG Stuttgart · New York

Erfolge in der Endoprothetik: Versorgung der Fingergelenke

Success in Total Joint Replacement: Management of Fínger Joints
K. Schmidt
1   Abteilung für Orthopädie und Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West, Dortmund
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Publication History

Publication Date:
23 October 2013 (online)

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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
 

  • Literatur

  • 1 An KN, Chao EY, Cooney WP et al. Forces in the normal and abnormal hand. J Orthop Res 1985; 3: 202-211
    CrossrefPubMedGoogle Scholar
  • 2 Brand PW, Hollister AM. Clinical mechanics of the hand. 3rd ed. St.Louis: Mosby; 1999
    Google Scholar
  • 3 Burgess SD, Kono M, Stern PJ. Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty. J Hand Surg Am 2007; 32: 1506-1512
    CrossrefPubMedGoogle Scholar
  • 4 Chao EYS, An KN, Cooney WP et al. Biomechanics of the hand. Singapure: World Scientific Publishing Co.Pte.Ltd.; 1989
    Google Scholar
  • 5 Adams BD, Blair WF, Shurr DG. Schultz metacarpophalangeal arthroplasty: a long-term follow-up study. J Hand Surg [Am] 1990; 15: 641-645
    CrossrefPubMedGoogle Scholar
  • 6 Berger RA, Beckenbaugh RD, Linscheid RL. Arthroplasty in the Hand and Wrist. In: Green DP, Hotchkiss RN, Pederdon WC. ed. Green’s operative Handsurgery. 4th ed. Philadelphia: Churchill Linvingstone; 1999: 147-191
    Google Scholar
  • 7 Bontemps E, Tillmann K. Langzeitergebnisse totaler Fingergelenkendoprothesen Modell „St Georg“. Handchir Mikrochir Plast Chir 1988; 20: 321-323
    PubMedGoogle Scholar
  • 8 Burman MS. Vitallium cap arthroplasty of the metacarpophalangeal and interphalangeal joints of the fingers. Bull Hosp Joint Dis 1940; 1: 79-89
    PubMedGoogle Scholar
  • 9 Cook SD, Beckenbaugh RD, Redondo J et al. Long-term follow-up of pyrolytic carbon metacarpophalangeal implants. J Bone Joint Surg Am 1999; 81: 635-648
    CrossrefPubMedGoogle Scholar
  • 10 Delaney R, Trail IA, Nuttall D. A comparative study of outcome between the Neuflex and Swanson metacarpophalangeal joint replacements. J Hand Surg Br 2005; 30: 3-7
    CrossrefPubMedGoogle Scholar
  • 11 Doi K, Kuwata N, Kawai S. Alumina ceramic finger implants: a preliminary biomaterial and clinical evaluation. J Hand Surg [Am] 1984; 9: 740-749
    CrossrefPubMedGoogle Scholar
  • 12 Englert HM. Eine neue intraossäre Fingergelenkendoprothese. Handchirurgie 1977; 9: 207-210
    PubMedGoogle Scholar
  • 13 Escott BG, Ronald K, Judd MG et al. NeuFlex and Swanson metacarpophalangeal implants for rheumatoid arthritis: prospective randomized, controlled clinical trial. J Hand Surg Am 2010; 35: 44-51
    PubMedGoogle Scholar
  • 14 Flatt AE, Ellison MR. Restoration of rheumatoid finger joint function. 3. A follow-up note after fourteen years of experience with a metallic-hinge prosthesis. J Bone Joint Surg [Am] 1972; 54: 1317-1322
    PubMedGoogle Scholar
  • 15 Griffiths RW, Nicolle FV. Three years’ experience of metacarpophalangeal joint replacement in the rheumatoid hand. Hand 1975; 7: 275-283
    PubMedGoogle Scholar
  • 16 Gschwend N. Operationen im Handbereich. In: Gschwend N. ed. Die operative Behandlung der chronischen Polyarthritis. 2 ed. Stuttgart: Thieme; 1977: 78-180
    Google Scholar
  • 17 Herren DB, Schindele S, Goldhahn J et al. Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results. J Hand Surg Br 2006; 31: 643-651
    CrossrefPubMedGoogle Scholar
  • 18 Honkanen PB, Tiihonen R, Skyttä ET et al. Bioreconstructive poly-L/D-lactide implant compared with Swanson prosthesis in metacarpophalangeal joint arthroplasty in rheumatoid patients: a randomized clinical trial. Hand Surg Eur Vol 2010; 35: 746-753
    PubMedGoogle Scholar
  • 19 Levack B, Stewart HD, Flierenga H et al. Metacarpo-phalangeal joint replacement with a new prosthesis: description and preliminary results of treatment with the Helal flap joint. J Hand Surg [Br] 1987; 12: 377-381
    CrossrefPubMedGoogle Scholar
  • 20 Lundborg G, Branemark PI, Carlsson I. Metacarpophalangeal joint arthroplasty based on the osseointegration concept. J Hand Surg [Br] 1993; 18: 693-703
    CrossrefPubMedGoogle Scholar
  • 21 Mayer B, Hagena FW. Fingergrundgelenksarthroplastik beim Rheumapatienten mit einer ungekoppelten, unzementierten Endoprothese. Handchir Mikrochir Plast Chir 2005; 37: 18-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 McArthur PA, Milner RH. A prospective randomized comparison of Sutter and Swanson silastic spacers. J Hand Surg [Br] 1998; 23: 574-577
    CrossrefPubMedGoogle Scholar
  • 23 Minami M, Yamazaki J, Kato S et al. Alumina ceramic prosthesis arthroplasty of the metacarpophalangeal joint in the rheumatoid hand. A 2–4-year follow-up study. J Arthroplasty 1988; 3: 157-166
    CrossrefPubMedGoogle Scholar
  • 24 Moller K, Sollerman C, Geijer M et al. Early results with osseointegrated proximal interphalangeal joint prostheses. J Hand Surg [Am] 1999; 24: 267-274
    PubMedGoogle Scholar
  • 25 Nicolle FV, Calnan JS. A new design of finger joint prosthesis for the rheumatoid hand. Hand 1972; 4: 135-146
    PubMedGoogle Scholar
  • 26 Niebauer JJ, Shaw JL, Doren WW. Silicone-dacron hinge prosthesis. Design, evaluation, and application. J Bone Joint Surg Am 1968; 50: 634-636
    PubMedGoogle Scholar
  • 27 Parker WL, Rizzo M, Moran SL et al. Preliminary results of nonconstrained pyrolytic carbon arthroplasty for metacarpophalangeal joint arthritis. J Hand Surg Am 2007; 32: 1496-1505
    CrossrefPubMedGoogle Scholar
  • 28 Petrolati M, Abbiati G, Delaria G et al. A new prosthesis for the metacarpophalangeal joint. Study of materials and biomechanics. J Hand Surg [Br] 1999; 24: 59-63
    PubMedGoogle Scholar
  • 29 Pettersson K, Wagnsjö P, Hulin E. NeuFlex compared with Sutter prostheses: a blind, prospective, randomised comparison of Silastic metacarpophalangeal joint prostheses. Scand J Plast Reconstr Surg Hand Surg 2006; 40: 284-290
    CrossrefPubMedGoogle Scholar
  • 30 Rittmeister M, Porsch M, Starker M et al. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty. Arch Orthop Trauma Surg 1999; 119: 190-194
    CrossrefPubMedGoogle Scholar
  • 31 Schetrumpf J. A new metacarpophalangeal joint prosthesis. Hand 1975; 7: 75-77
    PubMedGoogle Scholar
  • 32 Schmidt K, Miehlke RK, Witt K. Stand der Endoprothetik des Fingergrundgelenks beim Rheumatiker. Handchir Mikrochir Plast Chir 1996; 28: 254-264
    PubMedGoogle Scholar
  • 33 Schmidt K, Willburger R, Miehlke RK et al. Ten years follow-up of silicone arthroplasty of the metacarpophalangeal joints in the rheumatoid hand Scand J Plast Reconst Hand Surg 1999; 433-438
    PubMed
  • 34 Schmidt K, Willburger RE, Ossowski A et al. The effect of the additional use of grommets in silicone arthroplasty of the metacarpophalangeal joints. J Hand Surg 1999; 24B: 561-564
    PubMedGoogle Scholar
  • 35 Swanson AB. Finger joint replacement by silicone rubber implants and the concept of implant fixation by encapsulation. Ann Rheum Dis 1969; 28: 47-55
    PubMedGoogle Scholar
  • 36 Tägil M, Geijer M, Malcus P et al. Correlation between range of motion and implant fracture: a 5 year follow-up of 72 joints in 18 patients in a randomized study comparing Swanson and Avanta/Sutter MCP silicone prosthesis. J Hand Surg Eur Vol 2009; 34: 743-747
    CrossrefPubMedGoogle Scholar
  • 37 Tillmann K, Rüther W, Kranz R et al. Der Ersatz rheumatisch zerstörter Mittelhandköpfchen mit einem einstieligem Platzhalter. Akt Rheumatol 1989; 14: 259-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Varma SK, Milward TM. The Nicolle finger joint prosthesis: a reappraisal. J Hand Surg [Br] 1991; 16: 187-190
    CrossrefPubMedGoogle Scholar
  • 39 Vermeiren JA, Dapper MM, Schoonhoven LA et al. Isoelastic arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis: a preliminary report. J Hand Surg [Am] 1994; 19: 319-324
    PubMedGoogle Scholar
  • 40 Waljee JF, Chung KC. Objective functional outcomes and patient satisfaction after silicone metacarpophalangeal arthroplasty for rheumatoid arthritis. J Hand Surg Am 2012; 37: 47-54
    PubMedGoogle Scholar
  • 41 Weiss AP, Moore DC, Infantolino C et al. Metacarpophalangeal joint mechanics after 3 different silicone arthroplasties. J Hand Surg Am 2004; 29: 796-803
    CrossrefPubMedGoogle Scholar
  • 42 Wesemann A, Flügel M, Mamarvar M. Moje Prothese für das Fingermittelgelenk. Handchir Mikrochir Plast Chir 2008; 40: 189-196
    Article in Thieme ConnectPubMedGoogle Scholar