Pfannenplatzierung bei Daumensattelgelenksprothesen: Die Rolle des Führungsdrahts

Zusammenfassung

Hintergrund Die zunehmende Anwendung von Daumensattelgelenksprothesen bei fortgeschrittener Rhizarthrose reflektiert den Erfolg der jüngsten Prothesengenerationen durch ihre verbesserten funktionellen Ergebnisse und geringeren Komplikationsraten. Eine präzise Ausrichtung der Prothesenpfanne parallel zur proximalen Gelenkoberfläche des Trapeziums ist hierbei für die Stabilität und Vermeidung von Luxationen essenziell. Dies stellt gerade für den unerfahrenen „Beginner“ dieser Technik erfahrungsgemäß das größte Problem dar. Trotz adäquater Positionierung des Führungsdrahtes können Fehlplatzierungen der Pfanne auftreten, die eine intraoperativen Revision notwendig machen.

Material und Methoden Diese Studie untersucht die Abweichungen der Pfannen- und Führungsdrahtpositionierung bei Daumensattelgelenksprothesenimplantationen durch unerfahrene und erfahrene Operateure mittels radiologischer Analyse an 65 Prothesen.

Ergebnisse Sowohl unerfahrene als auch erfahrene Operateure erreichten eine präzise Führungsdrahtpositionierung mit mittleren Abweichungen von<2,2°. Unerfahrene zeigten signifikant größere Pfannenabweichungen im dorsopalmaren und lateralen Strahlengang (7,6±6,1° und 7,3±5,9°) im Vergleich zu erfahrenen Operateuren (3,6±2,7° und 3,6±2,5°; p=0,012, p=0,017). Die Abweichung der Pfanne zeigte bei unerfahrenen Operateuren eine jeweils entgegengesetzte Richtungstendenz zum Führungsdraht (p<0,0038).

Schlussfolgerung Die Ergebnisse verdeutlichen die aktuellen Herausforderungen bei der Pfannenpositionierung abhängig vom Erfahrungsgrad des Chirurgen und hinterfragen die Zuverlässigkeit des aktuellen Führungsdrahtsystems bei Prothesenimplantationen.

Abstract

Background The increasing use of thumb carpometacarpal joint prostheses for advanced CMC 1 (carpometacarpal) joint arthritis reflects the success of the latest prosthesis generations, which has been achieved through their improved functional outcomes and lower complication rates. Precise alignment of the prosthesis cup parallel to the proximal joint surface of the trapezium is essential for stability and the prevention of dislocation. This is a challenging surgical step, particularly for surgeons new to this technique. Despite adequate positioning of the guidewire, misplacements of the cup may occur, necessitating intraoperative revision.

Material and Methods This study examined the deviations in cup and guidewire positioning in thumb carpometacarpal joint prosthesis implantations by inexperienced and experienced surgeons through radiological analysis of 65 prostheses.

Results Both inexperienced and experienced surgeons achieved precise guidewire positioning with mean deviations of<2.2°. Inexperienced surgeons showed significantly larger cup deviations in the dorsopalmar and lateral view (7.6±6.1° and 7.3±5.9°) compared with experienced surgeons (3.6±2.7° and 3.6±2.5°; p=0.012, p=0.017). The deviation of the cup position exhibited by inexperienced surgeons tends to be in the direction opposite to the initial guidewire position (p<0.0038).

Conclusion The results highlight the current challenges in cup positioning depending on a surgeon’s level of experience, questioning the reliability of the current guidewire placement.

Schlüsselwörter

Rhizarthrose - Daumensattelgelenk - Endoprothese - Handchirurgie

Keywords

thumb metacarpophalangeal (MCP) joint - CMC1 - thumb arthritis - hand surgery

Publication History

Received: 12 February 2024

Accepted: 14 April 2024

Article published online:
11 June 2024

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