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Schulterendoprothetik im Alter

Hemi- oder Totalendoprothese? Anatomisch oder invers?

Shoulder endoprosthesis in the elderly

Hemiarthroplasty or total shoulder arthroplasty? Anatomic or reverse?

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Zusammenfassung

Neben der Standardversorgung mit anatomischen Schultertotalendoprothesen rückt bei älteren Patienten die Implantation von inversen Schulterendoprothesen immer mehr in den Vordergrund. Ursachen sind die steigende Lebenserwartung, die altersabhängige Degeneration der Rotatorenmanschette mit Ausbildung der Defektarthropathie, posttraumatische Zustände nach gescheiterter Osteosynthese und die primäre inverse Frakturendoprothetik. Die primäre Omarthrose mit erhaltener Rotatorenmanschette wird zunehmend mit schaftfreien Humerusimplantaten auch beim älteren Menschen versorgt, wobei die Knochenqualität limitierend ist. Moderne Endoprothesensysteme ermöglichen den schrittweisen Aufbau von knochensparenden Primärimplantaten zu modularen und konvertierbaren Revisionsimplantaten mit der Möglichkeit zu Teilwechseln. Die Revisionschirurgie, speziell von inversen Implantaten, bietet nur wenige Rückzugsmöglichkeiten, weshalb die Implantationen und Revisionen in spezialisierten Zentren durchgeführt werden sollten.

Abstract

Implantation of reverse shoulder endoprostheses is becoming more popular for elderly patients besides the well-established standard anatomic endoprostheses. The reasons for this are the increased life expectancy, age-dependent degeneration of the rotator cuff leading to cuff tear arthropathy, posttraumatic disability after failed osteosynthesis and primary reverse fracture arthroplasty. Stemless implants are more frequently used for primary osteoarthritis with the bone quality being the limiting factor. Modern implant systems allow the stepwise extension from bone preserving primary implants to modular and convertible revision implants that allow a partial exchange of components. Revision surgery, especially that of reverse arthroplasty, has limited potential for secondary treatment options and therefore implantation and revision should be performed in specialized treatment facilities.

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  1. Schulter- und Ellenbogenchirurgie, Klinik Fleetinsel Hamburg, Admiralitätstr. 3–4, 20459, Hamburg, Deutschland

    J. Kircher

  2. Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40255, Düsseldorf, Deutschland

    J. Kircher

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J. Kircher übt eine Berater- und Honorartätigkeit für die Firmen Limacorporate SPA und Arthrex aus.

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Kircher, J. Schulterendoprothetik im Alter. Orthopäde 46, 40–47 (2017). https://doi.org/10.1007/s00132-016-3365-3

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