[Endoprostheses of the hand]

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Reconstructive Surgery

Context:

• The historical use of arthroplasty dates back to the late 19th century, with early attempts using ivory for wrist joint replacement.
• Modern indications for hand arthroplasty include degenerative, post-traumatic, and arthritis-related joint destruction.
• Despite advancements, challenges persist in prosthetic design, material science, and biomechanical integration for hand joints.

Purpose:

• To review the historical development and current status of arthroplasty in the hand and wrist.
• To evaluate the efficacy and limitations of existing prosthetic designs, particularly silastic spacers.
• To identify unresolved issues in the biomechanics, materials, and fixation of hand joint prostheses.

Summary:

• Arthroplasty is used for various hand joint destructions, with early examples in the wrist and finger joints.
• Current prosthetic designs, like Swanson silastic spacers for metacarpophalangeal and proximal interphalangeal joints, show high patient satisfaction but limited active range of motion.
• Significant challenges remain in addressing complex hand joint biomechanics, material integration, and prosthesis design.

Impact:

• Highlights the persistent challenges in achieving optimal functional outcomes with current hand arthroplasty techniques.
• Suggests that further research is needed in biomechanics and materials to improve prosthetic joint function.
• Indicates a conservative approach for certain joints, such as recommending fusion over arthroplasty for the metacarpophalangeal joint of the thumb and avoiding distal interphalangeal joint arthroplasty.