Prosthetic surgery for the rheumatoid hand

In rheumatoid arthritis the complex biomechanics of the hand is impaired due to elongation of ligaments and displacement of tendons. This results in eccentric transfer of high loads to the arthritic joints. This pathological load transmission remains frequently after joint replacement. This is the main reason for the high failure rate after arthroplasty in the hand. Therefore, most of the endoprostheses are no longer in use. As long as techniques for reliable reconstruction of the periarticular structures have not been established, silicon arthroplasty will remain the golden standard. Arthroplasty of the wrist and the PIP joints is seldom performed. After arthrodesis of these joints, the function of the hand is sufficient and complications are seldom. Midterm results after resectional arthroplasty of the CMC-I joint show less complications and results comparable with silicon arthroplasty.