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Handchir Mikrochir Plast Chir 2021; 53(01): 40-46
DOI: 10.1055/a-1268-8190
Übersichtsarbeit

Übersicht über die Endoprothetik an den Fingergrund- und Mittelgelenken

Implant arthroplasty in the metacarpophalangeal and proximal interphalangeal finger joints
Marco Keller 
1   Handchirurgie, Kantonsspital Baselland, Liestal, Schweiz
,
Alissa Gübeli
1   Handchirurgie, Kantonsspital Baselland, Liestal, Schweiz
,
Philipp Honigmann
1   Handchirurgie, Kantonsspital Baselland, Liestal, Schweiz
2   Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, Universität Basel, Basel, Schweiz
3   Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Niederlande
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Zusammenfassung

Hintergrund Arthrotische Veränderungen der Fingergelenke sind häufig, insbesondere in der älteren Population. Unbehandelt können diese zu Schmerzen, Deformität, Instabilität oder Bewegungseinschränkung führen. Nebst Denervation und Arthrodese ist der prothetische Gelenkersatz eine mögliche operative Behandlungsmethode.

Patienten/Material und Methode Während der letzten Jahrzehnte erschienen diverse Prothesenmodelle zum Gelenkersatz des Fingergrund- und -mittelgelenkes auf dem Markt. Dieser Artikel bietet eine Übersicht über deren Entwicklung, heutige Prothesenmodelle, klinische Ergebnisse sowie zukunftsträchtige technische Neuheiten.

Ergebnisse Der seit den 1960er Jahren erhältliche Silikonspacer bleibt aufgrund guter klinischer Langzeitergebnisse, niedriger Revisionsraten sowie günstiger Kosten das Implantat der Wahl. Am Zeige- und Mittelfinger ist die laterale Stabilität wichtig, um dem Daumen beim Präzisionsgriff ein Widerlager zu bieten. Medullär verankernde Prothesen und modulare Oberflächenersatz-Prothesen können hier durch ihre erhöhte intrinsische Stabilität einen Vorteil bieten. Neue derartige Implantate zeigen vielversprechende mittelfristige klinische Ergebnisse.

Schlussfolgerung Obwohl sich die technischen Fortschritte auf dem Gebiet der Endoprothetik der großen Gelenke in der Vergangenheit nur bedingt auf die der Fingergelenke und der restlichen Hand übertragen ließen, gewinnen langsam auch Neuheiten wie patientenspezifische oder auf 3D-Druck-Technologie basierende Implantate an Bedeutung.

Abstract

Background Osteoarthritic changes in the finger joints are common, especially in the elderly population. Without adequate treatment, these changes can lead to pain, joint deformity, instability or impaired motion. Operative treatment options can be divided into prosthetic joint replacement, joint fusion and denervation.

Patients/Material and Method During the last decades, various prosthetic implant designs have appeared on the market. This article provides an overview of implant evolution, current implants, clinical results and promising technical novelties.

Results Due to favourable clinical long-term results, low revision rates and low costs, the proven silicone spacer has been the gold standard since the 1960 s. In the index and middle finger, lateral stability is crucial to providing a counter bearing to the thumb for a strong key pinch. Medullary-anchored prostheses and modular surface replacement designs have a higher intrinsic stability and may thus be advantageous in the index and middle finger. These implants show promising clinical medium-term results.

Conclusion In the past, technical novelties from big joint replacements could not automatically be translated to the finger joints and other parts of the hand. However, new trends such as customised or 3D-printed prosthetic implants are slowly beginning to gain importance in hand surgery.

Schlüsselwörter

Arthroplastik - Gelenkersatz - Prothese - Fingergrundgelenk - Fingermittelgelenk

Key words

Arthroplasty - joint replacement - prothesis - metacarpophalangeal joint - proximal interphalangeal joint


Publication History

Received: 02 June 2020

Accepted: 15 September 2020

Article published online:
14 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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