Die Endoprothetik des Handgelenkes

ZUSAMMENFASSUNG

In der Vergangenheit wurde der endoprothetische Ersatz des Handgelenkes nahezu ausschließlich bei älteren, „low-demand“ Patienten und bestehender rheumatoider Arthritis durchgeführt. Ein jüngeres Lebensalter, insbesondere im Zusammenhang mit einer posttraumatischen Arthrose gilt z. T. immer noch als Kontraindikation. Dieses Dogma hat sich inzwischen mit den guten mittelfristigen Erfahrungen im Umgang mit der 4. Prothesengeneration deutlich geändert. Für die derzeit verfügbaren Implantate werden Standzeiten von 86 % nach 10 Jahren (Motec) [1], 78 % über 15 Jahre (Universal 2) [2], oder 94 % für 8 Jahre (ReMotion) berichtet [3]. Hierbei ließen sich auch für die vermeintlich schwierigere Klientel der Jüngeren ein zuverlässiger Erhalt eines für die täglichen Dinge ausreichenden Bewegungsumfanges, eine zuverlässige Schmerzbefreiung und ein Zugewinn für die Griffstärke darstellen. Alternativ garantiert auch die Arthrodese des Handgelenkes keineswegs immer eine hohe Patientenzufriedenheit und niedrige Komplikationsrate. Dennoch reichen die bisherigen Publikationen, insbesondere aufgrund ihrer geringen Fallstärke, weiterhin nicht aus, um den künstlichen Handgelenkersatz über die Anwendung in wenigen Spezialzentren hinaus generell empfehlen zu können. Weiterhin lässt sich nicht beantworten, warum diesbezüglich die OP-Frequenz im Widerspruch zu den deutlich verbesserten Ergebnissen eher wieder abzunehmen scheint [4].

ABSTRACT

In the past, the endoprosthetic replacement of the wrist was performed almost exclusively in older, low-demand patients and existing rheumatoid arthritis. A younger age and thus post-traumatic arthrosis (PTOA) applies e. g. still as a contraindication. This dogma has meanwhile changed significantly with the good medium-term experience in dealing with the 4^th generation of prostheses. For the currently available implants, survival rates of 86 % after 10 years (Motec), 78 % over 15 years (Universal 2) or 94 % for 8 years (ReMotion) are reported. In this way, even for the supposedly more difficult clientele of the younger generation, reliable preservation of a range of motion sufficient for everyday things, reliable pain relief and an increase in grip strength could be represented. Alternatively, wrist arthrodesis does not always guarantee high patient satisfaction and a low complication rate. Nevertheless, the previous publications, especially due to their low drop size, are still insufficient to generally recommend artificial wrist replacement beyond use in a few special centers. Furthermore, there is no answer as to why the op frequency has dropped discordantly with the good results.

Schlüsselwörter

Arthrodese Handgelenk - rheumatoide Arthritis - Handgelenkarthrose - Totalendoprothese Hand - ReMotion^® - Freedom^® - Motec^®

Keywords

Wrist arthroplasty - total wrist fusion - rheumatoid arthritis - wrist arthritis - ReMotion - Freedom - Motec

Publikationsverlauf

Artikel online veröffentlicht:
02. November 2020

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