Endoprothetik des Handgelenks

Wrist implant arthroplasty represents a function-preserving alternative to joint arthrodesis in cases of advanced arthritis, osteonecrosis, and rheumatoid arthritis. Although fourth-generation implants have been available in Germany since the early 2000s, they still remain in limited use among hand surgeons in Germany.Using a combined approach, we performed a narrative review of the literature on the development of wrist implant arthroplasty, associated complications, and implant models. Additionally, an online survey was conducted to assess the current practice of wrist implant arthroplasty in Germany, supplemented by the results of a prospective data collection from our own patients with wrist prostheses. Subjective hand function and symptoms were evaluated using the DASH and PRHWE scores. Grip strength was measured, and the range of motion was assessed according to the neutral-zero-method. Complications and special cases were documented.Of the surveyed hand surgeons, 38% reported implanting wrist prostheses. The implantation of prostheses was primarily performed in older patients (>40 years) with rheumatoid arthritis, advanced post-traumatic and idiopathic arthritis, and osteonecrosis. During the study period from December 2022 to August 2025, 52 implanted MOTEC^® prostheses with a follow-up period of at least one year were recorded. There was a significant improvement in hand function, a reduction in load-dependent pain, and an improvement in mobility (extension/flexion, radial/ulnar deviation). In addition, a trend towards improved grip strength was noted, although statistical significance has not yet been reached. A total of 14 complications were observed, most of which were mechanically induced and partly infectious, and could be resolved through surgical revision.In summary, satisfactory functional results can be achieved with the implantation of wrist prostheses even in patients with high functional demands, such as younger and manually active individuals. However, the procedure is associated with a relatively steep learning curve and an increased complication rate, particularly in the context of the first prosthesis implantations.