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Der Gelenkersatz der Fingergrundgelenke

Metacarpophalangeal joint replacement

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Zusammenfassung

Hintergrund

Der Gelenkersatz der Fingergrundgelenke spielt vor allem bei Patienten mit rheumatoider Arthritis eine Rolle. Beweglichkeitserhaltende Verfahren sind für dieses Gelenk essenziell, da ein Verlust an Beweglichkeit zu einem ausgeprägten Funktionsverlust führen kann. Eine Vielzahl an Prothesen bzw. Platzhaltersysteme wurden in den letzten 80 Jahren entwickelt, die größtenteils aufgrund massiver Komplikationen wieder aufgegeben wurden.

Aktuelle Verfahren

Seit den 1960er-Jahren hat sich der „Swanson“ Platzhalter als Referenzstandard etabliert, die keine Prothese im eigentlichen Sinne darstellt, sondern vielmehr als Platzhalter fungiert. Auch die hohe Frakturrate dieser Systeme scheinen die Funktion und Patientenzufriedenheit nicht wesentlich zu schmälern. Aktuelle langfristige Untersuchungen zu Pyrocarbonprothesen für das Fingergrundgelenk zeigen bezüglich Bewegungsausmaß, Überlebensrate und Revisionsnotwendigkeit keine optimalen, aber zumindest konkurrenzfähige Ergebnisse im Vergleich zu den „Swanson“ Platzhalter.

Abstract

Background

Arthroplasty of metacarpophalangeal (MCP) joints is crucial for patients with rheumatoid arthritis. Motion preserving therapies are mandatory for this joint, since loss of function of the MCP joint is detrimental. Many protheses or spacers have been introduced over the last 80 years, but most of them have been dismissed due to major complications.

Current Procedures

Since the 1960s the Swanson spacer has been established as the reference standard for motion preserving procedures of the finger MCP joints. High fracture rates of the spacer do not seem to limit function and patient satisfaction after all. Current long-term studies show at least promising results for pyrolytic carbon protheses with respect to range of motion, survival, and revision rates in comparison to the Swanson spacer.

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Abbreviations

ICRS:

International Cartilage Research Society

MCP :

Metakarpophalangealgelenk

MHQ :

Michigan Hand Outcomes Questionnaire

ROM :

Bewegungsausmaß

VAS :

Visuelle Analogskala

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Authors and Affiliations

  1. Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland

    C. K. Spies & F. Unglaub

  2. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland

    M. F. Langer

  3. Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland

    S. Löw

  4. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    J. Oppermann & L. P. Müller

  5. Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Kliniken Stade-Buxtehude GmbH, Buxtehude, Deutschland

    B. Hohendorff

  6. Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland

    F. Unglaub

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  1. C. K. Spies
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Correspondence to C. K. Spies.

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Interessenkonflikt

C.K. Spies, M.F. Langer, L. Steffen, J. Oppermann, B. Hohendorff, L.P. Müller und F. Unglaub geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Spies, C.K., Langer, M.F., Löw, S. et al. Der Gelenkersatz der Fingergrundgelenke. Orthopäde 48, 386–393 (2019). https://doi.org/10.1007/s00132-019-03715-8

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