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Arthritis und Rheuma 2009; 29(05): 271-275
DOI: 10.1055/s-0037-1620182
Hand und Fuß
Schattauer GmbH

Stellenwert der Handgelenk -endoprothetik beim Rheumatiker

Total wrist arthroplasty in patients with rheumatoid arthritis
I. Arnold
1   Operative Rheumatologie und Orthopädie, Rheumazentrum Bremen, Rotes Kreuz Krankenhaus, Bremen
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
23. Dezember 2017 (online)

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Zusammenfassung

Ähnlich vergleichbar mit den früheren Erfahrungen die in Zusammenhang mit der Sprung-gelenkendoprothetik gesammelt wurde, las-sen sich die verlässlichen und guten Ergebnisse der Hüft- und Knieendoprothetik nicht oh-ne Einschränkungen auf die Handgelenksalloarthroplastik beim Rheumatiker übertragen. Erst die Entwicklung neuerer Prothesengenerationen, die der natürlichen Biomechanik der komplexen Gelenkverkettungen besser nachkommen, verspricht zukünftig eine Optimie-rung der Ergebnisse Der Behandlungserfolg ist insbesondere vom Gelingen einer guten Balancierung der physiologisch eher ungleich verteilten Weichteilkräfte abhängig. Hinsichtlich des Prothesendesigns hat sich ein modularer Prothesenaufbau der Komponenten durchgesetzt, auch wird die zementfreie Fixation bevorzugt. Vorherige Modelle versagten auch deshalb, weil es nicht gelang, die Kon-version von zwei auf einem Drehpunkt optimal zu rekonstruieren. Das frühere Problem der inakzeptablen Luxationsraten konnte durch Veränderung der Formgebung verbessert werden. Kritisch ist weiterhin die Zuverlässigkeit der karpalen Fixation der distalen Komponente einzuordnen. Im Falle eines Fehlschlages steht allerdings mit der Plattenarthrodese des Handgelenke eine zuverlässige Rückzugsmöglichkeit zur Verfügung.

Summary

Wrist involvement is common in patients with rheumatoid arthritis. But management of the end-stage rheumatoid wrist is controversial. The most common treatment is total wrist fusion. Fusion has been a very efficient treatment for people with severe pain caused by wrist degeneration. Pain is markedly improved. For patients who have already lost substantial motion, fusion provides a highly functional wrist. But when both wrists require fusion, the level of function remains far less acceptable. Total wrist arthroplasty offers a motion-preserving alternative. Existing data do not sup-port widespread application of total wrist arthroplasty for the rheumatoid arthritis wrist. The advantage of wrist arthroplasty remains controversial, primarily due to the high complication rate. The primary reasons for wrist replacement surgery are to relieve pain and to maintain function in the wrist and hand. A healthy wrist has two joints, but the wrist implants reduce motion to a single joint. The problem is that the wrist moves in so many directions and must be able to absorb and transmit a great deal of force in those positions. The anatomy of the wrist joint is extremely complex, probably the most complex of all the joints in the body. The result of total wrist joint arthroplasty depends very much on a careful patient selection. A preoperative bony malposition of the wrist and a tendon dysfunction seem to be responsible for a bad result. Many surgeons recommend fusing one wrist for strength and replacing the other wrist with an artificial wrist joint. This allows the patient to have one strong hand and one hand with a good range of motion. The best candidate is someone with severe wrist arthritis who is not routinely involved in activities placing high demands on the hand and wrist. A good reduction of pain can be achieved and approximately one-half of normal motion, which is sufficient for most tasks in the home or office, but the risk of complication is still higher than in arthrodesis. Wrist arthroplasty offers an alternative treatment for severe wrist arthritis in carefully selected patients.

Schlüsselwörter

Rheumatoide Arthritis - Handgelenkendoprothetik

Keywords

Rheumatoid arthritis - total wrist arthroplasty
 

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