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Arthritis und Rheuma 2011; 31(05): 325-333
DOI: 10.1055/s-0037-1618084
Endoprothetik und Rheuma
Schattauer GmbH

Ist der Swansonspacer immer noch Goldstandard beim rheumatisch destruierten Fingergelenk?

Swanson’s silicone arthroplasty is still the golden standard in rheumatoid destructed finger joints?
K. Schmidt
1   Abteilung für Orthopädie und Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
26. Dezember 2017 (online)

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Zusammenfassung

Rheumatisch destruierte Fingergelenke sind großen exzentrisch wirkenden Kräften ausgesetzt, die durch den krankheitsbedingten Fehlverlauf der gelenkübergreifenden Sehnen bedingt sind. Eine kräfterezentrierende Zwangsführung über Prothesen führt daher zwangsweise zu einem Bruch oder Ausbruch des Implantats. 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 peri implantären Vernarbung eine Korrektur der rheumatypischen Fehlstellungen. Verlässliche Rekonstruktionstechniken der periartikulären Strukturen zur Sehnenrezentrierung sind bis heute nicht etabliert worden. Die Silikonarthroplastik darf daher weiterhin als Goldstandard gelten, obwohl neuere Modifikationen des Silikonspacers tendenziell eine Verbesserung der eingeschränkten postoperativen Beweglichkeit ermöglichen.

Summary

Excentric displacement of tendons in rheumatoid hands generates high deviating loads on destructed joints. Recentation of the deviating forces by endoprotheses is frequently followed by fracture or loosening of the implants. Silicone arthroplasty, which was developed by Swanson about 50 years ago, avoids these problems. Scar formation around the silicone implant called encapsulation process corrects joint deviation and allows limited range of motion. Silicone arthroplasty will remain the golden standard in finger joint arthroplasty as long as reliable repair of the periarticular structures is not available. New modifications of the silicone implant afford slightly better ROM compared with the Swanson implant.

Schlüsselwörter

Rheuma - Handchirurgie - Arthroplastik

Keywords

Rheumatoid arthritis - handsurgery - arthroplasty
 

  • Literatur

  • 1 Arai K, Ishikawa H, Murai T. et al. Revision metacarpophalangeal joint replacement 30 years after primary swanson flexible silicone implant arthroplasty in a rheumatoid patient: a case report. Hand Surg 2009; 14 (01) 25-29.
    CrossrefPubMedGoogle Scholar
  • 2 Bass RL, Stern PJ, Nairus JG. High implant fracture incidence with Sutter silicone metacarpophalangeal joint arthroplasty. J Hand Surg [Am] 1996; 21 (05) 813-818.
    CrossrefPubMedGoogle Scholar
  • 3 Beevers DJ, Seedhom BB. Metacarpophalangeal joint prostheses. A review of the clinical results of past and current designs. J Hand Surg [Br] 1995; 20 (02) 125-136.
    CrossrefPubMedGoogle Scholar
  • 4 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 (10) 1506-1512.
    CrossrefPubMedGoogle Scholar
  • 5 Cook SD, Klawitter JJ, Weinstein AM. The influence of implant elastic modulus on the stress distribution around LTI carbon and aluminum oxide dental implants. J Biomed Mater Res 1981; 15 (06) 879-887.
    CrossrefPubMedGoogle Scholar
  • 6 Cook SD, Beckenbaugh RD, Weinstein AM, Klawitter JJ. Pyrolile carbon implants in the metacarpophalangeal joints of barboons. Orthopedics 1983; 6: 952-961.
    PubMedGoogle Scholar
  • 7 Cook SD, Beckenbaugh RD, Redondo J. et al. Longterm follow-up of pyrolytic carbon metacarpophalangeal implants. J Bone Joint Surg Am 1999; 81 (05) 635-648.
    CrossrefPubMedGoogle Scholar
  • 8 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 (01) 3-7.
    CrossrefPubMedGoogle Scholar
  • 9 Derkash RS, Niebauer Jr JJ. Lane CS. Long-term follow-up of metacarpal phalangeal arthroplasty with silicone Dacron prostheses. J Hand Surg [Am] 1986; 11 (04) 553-558.
    CrossrefPubMedGoogle Scholar
  • 10 Escott BG, Ronald K, Judd MG, Bogoch ER. Neu-Flex and Swanson metacarpophalangeal implants for rheumatoid arthritis: prospective randomized, controlled clinical trial. J Hand Surg Am 2010; 35 (01) 44-51.
    CrossrefPubMedGoogle Scholar
  • 11 Goldfarb CA, Stern PJ. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. J Bone Joint Surg Am 2003; 85 (10) 1869-1878.
    CrossrefPubMedGoogle Scholar
  • 12 Niebauer JJ, Shaw JL, Doren WW. Silicone-dacron hinge prosthesis. Design, evaluation, and application. J Bone Joint Surg Am 1968; 50 (03) 634-636.
    Google Scholar
  • 13 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 (10) 1496-1505.
    CrossrefPubMedGoogle Scholar
  • 14 Parkkila TJ, Belt EA, Hakala M. et al. Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg 2006; 40 (01) 49-53.
    CrossrefPubMedGoogle Scholar
  • 15 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 (05) 284-290.
    CrossrefPubMedGoogle Scholar
  • 16 Schmidt K, Miehlke RK, Witt K. Stand der Endoprothetik des Fingergrundgelenks beim Rheumatiker. Handchir Mikrochir Plast Chir 1996; 28 (05) 254-264.
    PubMedGoogle Scholar
  • 17 Schmidt K, Willburger RE, Ossowski A, Miehlke RK. The effect of the additional use of grommets in silicone arthroplasty of the metacarpophalangeal joints. J Hand Surg 1999; 24B: 561-564.
    Google Scholar
  • 18 Schmidt K. Endoprothetik des rheumatischen Langfingergrundgelenkes. arthritis + rheuma 2003; 23: 186-198.
    Google Scholar
  • 19 Swanson AB. Finger joint replacement by silicone rubber implants and the concept of implant fixation by encapsulation. Ann Rheum Dis 1969; 28 (Suppl. 05) 47-55.
    Google Scholar
  • 20 Swanson AB. Flexible implant arthroplasty for arthritic finger joints: rationale, technique, and results of treatment. J Bone Joint Surg [Am] 1972; 54 (03) 435-455.
    CrossrefPubMedGoogle Scholar
  • 21 Swanson AB, de Groot Swanson G. Flexible implant resection arthroplasty for the rheumatoid hand and wrist. Ann Chir Gynaecol Suppl 1985; 198: 54-69.
    PubMedGoogle Scholar
  • 22 Tägil M, Geijer M, Malcus P, Kopylov P. 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 2009; 34 (06) 743-747.
    CrossrefPubMedGoogle Scholar
  • 23 Trail IA, Martin JA, Nuttall D, Stanley JK. Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement. J Bone Joint Surg Br 2004; 86 (07) 1002-1006.
    CrossrefPubMedGoogle Scholar
  • 24 Weiss AP, Moore DC, Infantolino C. et al. Metacarpophalangeal joint mechanics after 3 different silicone arthroplasties. J Hand Surg Am 2004; 29 (05) 796-803.
    CrossrefPubMedGoogle Scholar