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[Prosthetic surgery for the rheumatoid hand].

K Schmidt1

  • 1Abteilung für Orthopädie und Rheumaorthopädie, Katholisches Krankenhaus Dortmund-West. k.schmidt@kirchlinde.kkhs.de

Der Orthopade
|December 24, 2004
PubMed
Summary

Rheumatoid arthritis impairs hand biomechanics, leading to joint damage and high failure rates for hand joint replacements. Silicon arthroplasty remains the standard due to challenges in reconstructing surrounding tissues.

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Area of Science:

  • Orthopedics
  • Rheumatology
  • Biomedical Engineering

Background:

  • Rheumatoid arthritis (RA) significantly disrupts hand biomechanics, causing ligament elongation and tendon displacement.
  • This leads to abnormal load transmission onto arthritic joints, a persistent issue even after joint replacement surgery.
  • The high failure rate of hand arthroplasty is primarily attributed to pathological load transmission.

Purpose of the Study:

  • To evaluate the efficacy and complication rates of different surgical interventions for rheumatoid arthritis affecting the hand.
  • To compare silicon arthroplasty with alternative procedures like arthrodesis and resectional arthroplasty.

Main Methods:

  • Review of existing literature and clinical outcomes for hand arthroplasty in rheumatoid arthritis patients.
  • Analysis of complication rates and functional outcomes for silicon arthroplasty, wrist and PIP joint arthrodesis, and CMC-I joint resectional arthroplasty.

Main Results:

  • Most hand endoprostheses are currently not in use due to high failure rates.
  • Silicon arthroplasty is considered the gold standard in the absence of reliable methods for periarticular structure reconstruction.
  • Arthrodesis of the wrist and proximal interphalangeal (PIP) joints offers sufficient hand function with fewer complications.
  • Midterm results of resectional arthroplasty for the carpometacarpal-I (CMC-I) joint show promising outcomes with fewer complications compared to silicon arthroplasty.

Conclusions:

  • Effective reconstruction techniques for periarticular structures are crucial for improving hand arthroplasty outcomes.
  • Arthrodesis is a viable and less complicated option for wrist and PIP joint involvement in RA.
  • Resectional arthroplasty of the CMC-I joint presents a favorable alternative to silicon arthroplasty with comparable midterm results and lower complication rates.

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