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Handgelenkendoprothesen

Indikation und Technik

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Posttraumatische Arthrosen, primär-degenerative Arthrosen, Destruktionen im Rahmen entzündlicher Systemerkrankungen und andere Läsionen können zu Schmerzen, Fehlstellungen, Instabilitäten und Funktionsverlusten im Handgelenkbereich führen. Neben Resektionen von zerstörten Gelenkanteilen, Teilfusionen von Handwurzelknochen und radiokarpalen Teilarthrodesen stellt die Handgelenkarthrodese heute einen Standardeingriff zur Therapie dieser Beschwerden dar.

Um eine schmerzfreie Beweglichkeit zu erhalten, wurden verschiedene Typen des alloarthroplastischen Handgelenkersatzes entwickelt.

Im Zeitraum von 1996–1998 wurden 40 Handgelenkendoprothesen (Typ APH: Anatomisch Physiologisches Handgelenk) vorwiegend bei Patienten mit fortgeschrittenen Gelenkdestruktionen im Rahmen einer rheumatoiden Arthritis implantiert. Keine Prothese wies eine längere Standzeit auf. Alle Handgelenke mussten durch eine Revisionsarthrodese therapiert werden.

Weder Angaben in der Literatur noch eigene Erfahrungen konnten bisher einen Handgelenkendoprothesentyp beschreiben, der zufrieden stellende Ergebnisse auch im Verlauf erwarten lässt. Die Indikation zur Handgelenkendoprothetik sollte daher zurückhaltend und sehr kritisch gestellt werden.

Abstract

Traumatic arthrosis, osteoarthrosis, rheumatoid arthritis and other lesions in the region of the wrist can lead to severe pain, malposition, instability and malfunction of the wrist joint. Resections of the parts of the joint that have been destroyed, partial fusions and wrist arthrodesis are currently the standard methods of treating these conditions. Different types of total wrist arthroplasty have been developed, with the aim of achieving painfree motion in various conditions.

From 1996 to 1998 40 total wrist arthroplasties (APH: Anatomic Physiological Wrist) were implanted, in patients with advanced destruction of the wrist as a result of rheumatoid arthritis. There were no implants that had been in place longer. In all these cases, revision arthrodesis of the wrist joint concerned was necessary. It has not so far proved possible on the basis of either literature reports or the authors' own experience to describe any type of total wrist implant arthroplasty that would justify expecting satisfactory results within a reasonable period of time. Caution and hesitation must therefore be exercised in decisions on whether arthroplasty is indicated.

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Authors and Affiliations

  1. Orthopädie—Rheumachirurgie, Immanuel-Krankenhaus Berlin

    M. Lautenbach & M. Sparmann

  2. Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin

    A. Eisenschenk

  3. Orthopädie—Rheumachirurgie, Immanuel-Krankenhaus Berlin, Königstraße 63, 14109 , Berlin

    M. Lautenbach

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  1. M. Lautenbach
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  2. A. Eisenschenk
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  3. M. Sparmann
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Correspondence to M. Lautenbach.

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Lautenbach, M., Eisenschenk, A. & Sparmann, M. Handgelenkendoprothesen. Trauma Berufskrankh 5, 308–314 (2003). https://doi.org/10.1007/s10039-003-0780-6

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