Prosthetic replacement of wrist and finger joints is a key stone in the surgical treatment in rheumatoid arthritis. Severely destroyed joints are a source of pain and create deformities, which will severely affect the functionality of the hand. The wrist joint consists of a radiocarpal joint which provides flexion/extension and a radio-ulnar joint which allows pro-/ supination.
A mobile radiocarpal joint helps to compensate for impaired elbow and finger joint. There is a variety of wrist prosthesis on the market. Overall the results with these prosthetic devices are mixed. There is generally a high failure rate with sometimes difficult revisions situations due to missing bone stock. The Swanson silastic implant, with reasonable longtime results, might be an alternative to preserve some motion. Nevertheless arthrodesis is still the gold standard on which the current wrist implants have to be measured. On the level of the radio-ulnar joint ulnar head resection is still accepted as treatment of choice in most instances. Unstable distal ulnar stumps and loss of power grip raised the wish for an alternative. There is a new distal ulnar head prosthesis on the marked, which might be an possible implant for the future for selected cases.
On the level of the finger joints Swansons silastic implants, also in newer different designs, are still the implants of choice for most surgeons. High implant failure rate and the wish to go away from Silastic as implant material, motivated different authors for new implant designs and the use of newer materials. Despite these efforts a real breakthrough as well in design as in materials is still somewhat missing. Carbon fibre based materials or ceramics might have a good potential for the future.
Besides the implant design and the material, the understanding of soft tissue pathomechanics and its consequences for prosthetic replacement is raising. Ligament reconstruction and possible use of artificial ligaments might be a concept for the future.
The lecture should give an understanding of the pathomechanics of rheumatoid arthritis and its consequences for prosthetic replacement. It should give an overview of current prosthetic designs and their clinical results and provide an outlook of new concepts of prosthetic replacement and future development.
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