Sports injuries, misalignments or age-related osteoarthritis - the list of possible causes of joint damage is long. In particularly severe cases, curative (healing) treatment of the damaged joint is no longer possible. This is where arthroplasty comes into play - the replacement of joints and body structures with artificial "likenesses". Wrist replacement, also known as hand arthroplasty, is particularly complex.
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Doctors who have been awarded the seal are medical facilities that have been certified as an EndoProstheticsCenter (EPC) or as an EndoProstheticsCenter of Maximum Care (EPCmax) via endocert and have therefore demonstrated compliance with the requirements set out in an audit. Recertification is required every three years.
The criteria, requirements and differences between EPZ and EPZmax can be found here.
A look at the operation statistics reveals that the number of endoprostheses continues to rise every year. In Germany, the knee is most frequently affected, closely followed by hip replacement. However, the shoulder and wrist can also benefit from an endoprosthesis if the joint can no longer be saved. It is no longer just old people who are affected. More and more young, sporty people also need a joint replacement at an early stage.
In everyday life, the hand and therefore also the wrist is a real "high-performance organ". We feel, touch, work and carry loads with the help of our hands. This makes it all the more painful when the wrist fails due to an accident or decades of overuse or only causes pain.
Torn ligaments occur quite frequently, for example, or falls and accidents can lead to fractures of the fine bones of the joint. If the wrist can no longer be maintained surgically, it must be replaced with a hand endoprosthesis.
In general, an artificial joint must fulfill many conditions in order to be used safely. For example, it should be durable, i.e. it will not change even after years in the body. In addition, an artificial joint must be compatible so that it does not cause immune reactions or organ damage. A certain degree of stability against fractures and a lightweight design are of course just as important.
Patients can now choose from a whole range of possible materials for a hand endoprosthesis. Metal alloys, e.g. iron, cobalt and titanium, have been researched the most. There are also plastics such as polyethylene, ceramics and bone cement.
However, research has not yet succeeded in imitating the synovial fluid that occurs naturally in the joint. Depending on the material used, the lack of lubrication causes friction and play in the bone during joint replacement, which can result in both abrasion and loosening of the endoprosthesis in the bone. Granulomas as well as metal and ceramic fractures have also been described. Corrosion is to be expected in some cases due to the warm and humid body environment.
However, researchers around the world are continuing to work on developing an increasingly natural joint replacement that meets the requirements of longevity and low complication rates.
Unfortunately, complications can never be completely ruled out, despite very good care structures at specialized clinics for joint replacement. In older patients, for example, prosthesis loosening occurs in some cases due to insufficient bone regeneration. This affects around 8% of all joint endoprostheses within a period of 10 years after implantation. The loosening of the prosthesis makes the entire restored joint unstable, which is why the only remaining measure is often a new operation.
However, prosthesis wear is also possible. In this case, material from the prosthesis is released due to the increased friction on the joint surface. Studies on knee joint prostheses, for example, have previously shown that titanium particles are rubbed off the endoprosthesis and then accumulate in cells of the immune system, which can lead to inflammatory reactions in the joint replacement.
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