Radmer S, Andresen R, Sparmann M
Department of Rheumatic Surgery, Immanuel Hospital, Berlin, Germany.
J Hand Surg Am. 1999 Sep;24(5):935-43. doi: 10.1053/jhsu.1999.0935.
The function of the wrist is frequently considerably impaired by early destruction in patients with rheumatoid arthritis. The aim of endoprosthetic arthroplasty is to restore functional use and provide freedom from pain. In our study a newly developed, uncemented wrist prosthesis was implanted in 30 patients (24 women and 6 men) with advanced destruction of the wrist. This wrist prosthesis is a hydroxyapatite-coated cobalt-chrome prosthesis with a titanium coating of the articular surfaces. The radial component has an articular surface inclination of 10 degrees toward the ulna, and the carpal component, which is anchored with its tip in the distal carpal bones and third metacarpal bone, has a double articular surface with a radial inclination of 10 degrees. At the 18-month follow-up visit, the following parameters were examined: x-ray, grip strength, range of motion, and the patient's subjective satisfaction. Good improvement of function was found in 92% of the patients; 87% were free of pain. Eighty-eight percent of the patients rated the outcome of surgery as good. If the indication is accurately diagnosed, this wrist prosthesis can markedly improve function, which in turn leads to high patient acceptance. Various salvage procedures remain open because of the minimal loss of bone stock and the uncemented implantation of the prosthesis.
