Endoprothetik am Daumensattelgelenk

Abstract

The role of joint replacement in the treatment of osteoarthritis of the thumb carpometacarpal joint is a subject of considerable controversy in the current literature. In German-speaking countries this technique is used much less frequently than resection procedures. Aseptic loosening of the prosthesis is believed to be the major cause of the high failure rates reported for cemented and uncemented types of implants. In this study the different implant designs were evaluated on the basis of the results reported in the international literature. There are only a few studies that cover relatively long follow-up periods and provide convincing results for thumb carpometacarpal joint prostheses in terms of implant survival and function. Aseptic loosening is reported to be the major cause with failure rates of 50 % or more. Although a Norwegian study reported high 5 and 10-year survival rates for various thumb carpometacarpal joint prostheses according to the Norwegian arthroplasty registry, it did not recommend the widespread use of thumb carpometacarpal joint replacement at the present time. In our opinion, joint replacement may be considered as a possible treatment option for advanced osteoarthritis of the thumb carpometacarpal joint but it should not always be recommended because long-term results are inconsistent and similar functional outcomes have been reported for alternative surgical techniques, such as resection arthroplasty.

Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis

“…In patients, who decided for implantation of a Maïa prosthesis, all contraindications for the implants had to be excluded (mild scaphotrapeziotrapezoidal [STT] osteoarthritis was tolerated), otherwise they received a resection arthroplasty. 1 Operation time was collected as well as possible complications in the postoperative course and during follow-up period.…”

“…It is caused by the special anatomy of the joint, which not only offers a wide range of motion but also induces a big strain to the joint of up to 200 kg in pinch grip. [1][2][3][4] Moderate to severe degrees of osteoarthritis might require surgical treat-ment for the purpose of restoring pain-free, strong, stable, and mobile function of the thumb and to improve patient global assessment. 4 Trapeziectomy remains the most common surgical treatment for thumb carpometacarpal (CMC) joint osteoarthritis.…”

“…[4][5][6][7][8] None of these surgical methods have proved to provide superior results compared with the other techniques. 1 Furthermore, some of the procedures may be associated with negative effects such as deep pain and tendon problems. [9][10][11] In 1973, De la Caffiniere described the replacement of the thumb CMC joint for the first time.…”

“…In different studies partly, good long-term survival is reported. 1,6,16,17 The reported revision and complication rates differ in a high range. 2,4,6,[18][19][20][21] In the German-speaking world, the use of prostheses in the treatment of thumb CMC osteoarthritis is only 5%, perhaps also caused by the higher costs of the prosthesis compared with the low-cost resection arthroplasty.…”

“…2,4,6,[18][19][20][21] In the German-speaking world, the use of prostheses in the treatment of thumb CMC osteoarthritis is only 5%, perhaps also caused by the higher costs of the prosthesis compared with the low-cost resection arthroplasty. 1 The patients are becoming younger, and some are still employed when they need operative treatment. They not only want to return to work as soon as possible, but also to practice their prior sports after operation.…”