Zusammenfassung
Die Endoprothetik des Daumensattelgelenks zur Behandlung der Rhizarthrose erfährt in der zeitgenössischen Literatur eine z. T. diametrale Würdigung. Im deutschsprachigen Raum spielt sie quantitativ gegenüber den resezierenden Verfahren eine untergeordnete Rolle. Die aseptische Lockerung der Prothese gilt als die wesentliche Ursache für die z. T. hohen Versagensraten der zementierten wie zementfreien Prothesentypen. In der vorliegenden Arbeit werden Resultate aus der internationalen Literatur zu unterschiedlichen Prothesendesigns vorgestellt und eine aktuelle Bewertung vorgenommen.
Es finden sich wenige Studien mit längeren Nachbeobachtungsphasen, die für die verwendeten Daumensattelgelenkprothesen überzeugende Resultate hinsichtlich ihrer Standfestigkeit und Funktionalität vorstellen. Mehrheitlich wird die aseptische Auslockerung als Versagensursache mit Quoten bis über 50 % angeführt. Auch hohe Überlebensraten unterschiedlicher Daumensattelgelenkprothesen nach 5 und 10 Jahren im norwegischen Endoprothesenregister veranlassten die Untersucher nicht zu der Empfehlung einer weiten Indikationsstellung dieser Methode zum gegenwärtigen Zeitpunkt. Aus Sicht der Autoren ist daher die endoprothetische Versorgung zur Therapie der fortgeschrittenen Rhizarthrose dem Patienten als Alternative zu erläutern, aber aufgrund der widersprüchlichen Langzeitergebnisse und des vergleichbaren funktionellen Outcomes alternativer Operationsverfahren, wie z. B. den Resektionsarthroplastiken des Daumensattelgelenks, aktuell nicht zwingend zu empfehlen.
Abstract
The role of joint replacement in the treatment of osteoarthritis of the thumb carpometacarpal joint is a subject of considerable controversy in the current literature. In German-speaking countries this technique is used much less frequently than resection procedures. Aseptic loosening of the prosthesis is believed to be the major cause of the high failure rates reported for cemented and uncemented types of implants. In this study the different implant designs were evaluated on the basis of the results reported in the international literature. There are only a few studies that cover relatively long follow-up periods and provide convincing results for thumb carpometacarpal joint prostheses in terms of implant survival and function. Aseptic loosening is reported to be the major cause with failure rates of 50 % or more. Although a Norwegian study reported high 5 and 10-year survival rates for various thumb carpometacarpal joint prostheses according to the Norwegian arthroplasty registry, it did not recommend the widespread use of thumb carpometacarpal joint replacement at the present time. In our opinion, joint replacement may be considered as a possible treatment option for advanced osteoarthritis of the thumb carpometacarpal joint but it should not always be recommended because long-term results are inconsistent and similar functional outcomes have been reported for alternative surgical techniques, such as resection arthroplasty.
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E. Kollig, D. Bieler und A. Franke geben an, dass kein Interessenkonflikt besteht.
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M. Schädel-Höpfner, Neuss
Dieser Beitrag beinhaltet Daten einer Verlaufsbeobachtung an Patienten nach Implantation einer zementfreien Keramikendoprothese. Diese Verlaufsbeobachtung ist beim Journal of Hand Surgery European Volume zur Veröffentlichung eingereicht.
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Kollig, E., Bieler, D. & Franke, A. Endoprothetik am Daumensattelgelenk. Unfallchirurg 119, 1007–1014 (2016). https://doi.org/10.1007/s00113-016-0252-7
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DOI: https://doi.org/10.1007/s00113-016-0252-7