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 joint replacement surgery—the replacement of joints and body structures with artificial “replicas”—comes into play. Wrist replacement, also known as wrist arthroplasty, is particularly complex.
.png "Endocert Zertifizierung")
Physicians who hold this seal are affiliated with medical facilities that are certified by endocert as an Endoprosthetics Center (EPZ) or as a Maximum Care Endoprosthetics Center (EPZmax) and have thus demonstrated through an audit that they meet the established requirements. Recertification is required every three years.
The criteria, requirements, and differences between EPZ and EPZmax can be found here.
A look at surgical statistics reveals that the number of joint replacements continues to rise every year. In Germany, the knee is the most commonly affected joint, closely followed by hip replacement. However, the shoulder and wrist can also benefit from an endoprosthesis if the joint can no longer be saved. This is no longer limited to older people. An increasing number of young, athletic people also require joint replacement at an early stage.
In everyday life, the hand—and thus the wrist—is a true “high-performance organ.” We use our hands to feel, touch, work, and carry loads. This makes it all the more painful when the wrist fails—whether due to an accident or decades of overuse—or causes nothing but pain.
Torn ligaments are quite common, for example, or falls and accidents can lead to fractures of the delicate bones in the joint. If the wrist can no longer be preserved surgically, it must be replaced with a wrist prosthesis.
In general, an artificial joint must meet many requirements to be safely implanted. For example, it must be biocompatible, meaning it will not change even after years inside the body. Furthermore, an artificial joint must be well-tolerated so that it does not trigger immune reactions or cause organ damage. A certain degree of fracture resistance and a lightweight design are, of course, also essential.
Patients now have a wide range of potential materials to choose from for a hand prosthesis. The most extensively researched materials to date are metal alloys, such as those made of iron, cobalt, and titanium. Other options include plastics like polyethylene, ceramics, and bone cement.
However, researchers have not yet succeeded in mimicking the synovial fluid that occurs naturally in the joint. Due to the lack of lubrication, joint replacement can lead to friction and play within the bone—depending on the material used—which can result in both wear and loosening of the endoprosthesis within the bone. Similarly, granulomas as well as metal and ceramic fractures have already been reported. Due to the warm, moist environment inside the body, signs of corrosion can sometimes be expected.
However, researchers around the world are continuing to work on developing increasingly natural joint replacements that meet the requirements for durability and a low complication rate.
Unfortunately, despite very good care systems at specialized joint replacement clinics, complications can never be completely ruled out. In older patients, for example, prosthesis loosening occurs in some cases due to insufficient bone regeneration. This affects approximately 8% of all joint replacements within a 10-year period following implantation. Prosthesis loosening destabilizes the entire replaced joint, which is why reoperation is often the only remaining option.
However, prosthesis wear is also a possibility. In this process, material from the prosthesis is released due to increased friction on the joint surfaces. Studies on knee joint prostheses, for example, have previously shown that titanium particles are abraded from the prosthesis and then accumulate in immune system cells, which can lead to inflammatory reactions at the joint replacement site.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
