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Schaftbezogene Revisionseingriffe in der Schulterendoprothetik

Ursachenanalyse und Ergebnisse in 52 Fällen

Revision arthroplasty of the humeral component

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Summary

Fifty-two patients underwent a total of 78 revision surgeries performed for failed primary shoulder arthroplasty and were followed up for a mean of 32 months. The indications for primary arthroplasty included: humeral head fracture (20), osteoarthritis (14), posttraumatic avascular head necrosis (11), cuff tear arthropathy (6) and rheumatoid arthritis (1). Indications for revision surgery included pain, restricted motion and infection. Intraoperatively, disorders were identified and attributed to pathology present on the humeral side related to bone loss or failure (38 %), soft tissue injury (29 %), implant failure (21%) or infection (12 %). At follow-up the mean Constant score improved from an average of 15 points preoperatively (range, 0 to 73 points) to 40 points (range, 0 to 89 points) postoperatively (p<0.05). On the VAS pain decreased from an average of 7.2 points (with 10 as maximum pain) to 3.2 points (p<0.05). Significant increases (p<0.001) in post-operative range of motion were seen in flexion (improved from 42° to 80°) and abduction (improved from 37° to 76°). Increase of external rotation (improved from 13° to 20°) was not significant (p>0.05). On the humeral side good outcomes resulted in cases that were revised for implant failures. Revisions performed for bone and soft tissue related failures had poor to moderate outcomes due to underlying rotator cuff deficiency.

Zusammenfassung

52 Patienten mit insgesamt 78 Revisionseingriffen nach Implantation einer Schulterprothese wurden retrospektiv nach durchschnittlich 32 Monaten klinisch und radiologisch nachuntersucht. Die Indikation zum prothetischen Gelenkersatz war eine Humeruskopffraktur in 20 Fällen (38 %), eine Omarthrose in 14 (27 %), eine posttraumatische avaskuläre Kopfnekrose in 11 (22 %), eine Cuffarthropathie in 6 (11 %) sowie rheumatoide Arthritis in einem Fall (2 %). Insgesamt wurden 44 Hemiprothesen (85%) und 8 Totalendoprothesen (15%) revidiert. Die Indikationen zur Revision waren Schmerz, Bewegungseinschränkung und Protheseninfekt. Intraoperativ wurde die im Vordergrund stehende Pathologie eingeteilt nach (1) knöchernen (38%), (2) weichteilbezogenen (29 %), (3) implantatbezogenen (21 %) und (4) infektbedingten (12%) Ursachen. Der Constant Score konnte von durchschnittlich 15 (0 bis 73 Punkten) auf 40 Punkte (0 bis 89 Punkte) gesteigert werden (p<0.05). Auf einer VAS (0 kein Schmerz—10 stärkste Schmerzen) sank das Schmerzniveau von 7,2 auf 3,2 Punkte (p<0,05). Anteflexion (von 42° auf 80°) und Abduktion (von 37° auf 76°) verbesserten sich statistisch hochsignifikant (p<0,001). Die Steigerung der Außenrotation (von 13° auf 20°) war nicht signifikant (p>0,05).

Gute Ergebnisse nach Revisionseingriffen in der Schulterprothetik sind bei implantatbezogenen Ursachen zu erwarten. Bei knöchernen sowie weichteilbezogenen Ursachen sind die Ergebnisse in der Regel nur mäßig aufgrund der vorliegenden Rotatorenmanschetteninsuffizienz.

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Authors and Affiliations

  1. Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    M. Tauber,  E. Ritter &  H. Resch

  2. Department of Orthopaedics, Hospital for Special Surgery, New York, USA

    B. Kelly

  3. Wissenschaftliche Abteilung für Biostatistik, Paracelsus Medizinische Universität, Salzburg, Austria

    W. Hitzl PhD

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  1. M. Tauber
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  2. E. Ritter
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  3. B. Kelly
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  4. W. Hitzl PhD
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  5. H. Resch
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Correspondence to M. Tauber.

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Tauber, M., Ritter, E., Kelly, B. et al. Schaftbezogene Revisionseingriffe in der Schulterendoprothetik. Obere Extremität 1, 8–15 (2006). https://doi.org/10.1007/s11678-006-0008-z

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  • DOI: https://doi.org/10.1007/s11678-006-0008-z

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