Advertisement

Der Orthopäde

, Volume 46, Issue 12, pp 1008–1014 | Cite as

Humerale und glenoidale Knochendefekte in der Schulterendoprothetik

Klassifikation und Behandlungsprinzipien
Leitthema

Zusammenfassung

Technik

Die Behandlung von Knochendefekten bei der primären Schulterendoprothetik hat in den letzten Jahren durch verfeinerte Methoden der Computertomographie(CT)-Diagnostik und 3‑D-Planung sowie die Ausweitung der Indikation für inverse Totalendoprothesen große Fortschritte gemacht. Wegen der häufig begleitenden chronischen Dezentrierung des Humeruskopfes werden selbst bei erhaltener Rotatorenmanschette zunehmend inverse Implantate in Kombination mit einem Glenoidaufbau bevorzugt. Parallel dazu hat die Behandlung der Glenoidlockerung mit fortgeschrittenem Knochenverlust durch die zementfreie Fixation der Basisplatte und Transfixationstechnik nach Norris eine grundlegende Veränderung erfahren. Die Operationstechnik erfordert sowohl bei der primären Endoprothetik als auch bei Revisionen eine detaillierte präoperative Planung mittels reformatierter Röntgen-CT und spezieller Instrumentation.

Ergebnisse

Die Revisions- und Komplikationsraten sind bei Wechseloperationen mit ausgeprägten Glenoiddefekten und langstreckigen Knochenverlusten am Humerus hoch. Die funktionellen Ergebnisse sind insbesondere nach mehrfachen Voroperationen und bei begleitenden Schäden des Weichteilmantels oft mäßig.

Schlüsselwörter

Arthrose Revisionschirurgie Rotatorenmanschette Glenoid Schultergelenkersatz 

Abkürzungen

BIO-RSA

„Bony-increased offset-reverse shoulder arthroplasty“

CT

Computertomographie

PE

Polyethylen

TEP

Totalendoprothese

Humeral and glenoid bone loss in shoulder arthroplasty

Classification and treatment principles

Abstract

Technique

The treatment of bone defects in primary shoulder arthroplasty has evolved due to more detailed diagnostic tools, 3D planning and expanded indications for reverse shoulder arthroplasty. Glenoid bone defects combined with chronic posterior subluxation of the humeral head are gradually being treated by glenoid reconstruction and reverse implants even if the rotator cuff is still intact. The treatment of advanced bone loss due to glenoid loosening has been facilitated by bone augmentation using a cementless fixation as proposed by Norris. Precise pre-operative planning using reformatted computed tomography (CT) and dedicated instruments is recommended in primary and revision arthroplasty.

Results

Revision rates and complications are high for revision surgery in extended glenoid and humeral bone loss. Functional results are limited in these cases, particularly after multiple operations and damage of the soft tissue envelope.

Keywords

Osteoarthritis Revision surgery Rotator cuff Glenoid Shoulder arthroplasty 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Gohlke und B. Werner sind als Consultant in beratender Funktion für Wright/Tornier tätig.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Antuna SA, Sperling JW, Cofield RH, Rowland CM (2001) Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 10(3):217–224CrossRefPubMedGoogle Scholar
  2. 2.
    Bercik MJ, Kruse K, Yalizis M, Gauci MO, Chaoui J, Walch G (2016) A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 25:1601–1606CrossRefPubMedGoogle Scholar
  3. 3.
    Boileau P, Morin-Salvo N, Gauci MO, Seeto BL, Chalmers PN, Holzer N, Walch G (2017) Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management glenoid bone loss and erosion. J Shoulder Elbow Surg.  https://doi.org/10.1016/j.jse.2017.05.024 Google Scholar
  4. 4.
    Daggett M, Werner B, Gauci MO, Chaoui J, Walch G (2016) Comparison of glenoid inclination angle using different clinical imaging modalities. J Shoulder Elbow Surg 25:180–185CrossRefPubMedGoogle Scholar
  5. 5.
    Farron A, Terrier A, Büchler P (2006) Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg 15(4):521–526CrossRefPubMedGoogle Scholar
  6. 6.
    Formaini NT, Everding NG, Levy JC, Santoni BG, Nayak AN, Wilson C, Cabezas AF (2015) The effect of glenoid bone loss on reverse shoulder arthroplasty baseplate fixation. J Shoulder Elbow Surg 24(11):e312–e319CrossRefPubMedGoogle Scholar
  7. 7.
    Garcia-Fernandez C, Lopiz-Morales Y, Rodriguez A, Lopez-Duran L, Martinez FM (2015) Periprosthetic humeral fractures associated with reverse total shoulder arthroplasty: incidence and management. Int Orthop 39:1965–1969CrossRefPubMedGoogle Scholar
  8. 8.
    Gohlke F, Werner B (2009) Humeral bone defects in revision and primary shoulder arthroplasty. Proc. SECEC 2009, Madrid.Google Scholar
  9. 9.
    Gohlke F, Wiese I, Hudek R, Werner B (2017) How to deal with glenoid loosening. In: Valenti, Hardy, Scheibel (Hrsg) Shoulder arthroplasty–current concepts Proceedings of PISC.Google Scholar
  10. 10.
    Hill JM, Norris TR (2001) Long-term results of total shoulder arthroplasty following bone grafting of the glenoid. J Bone Joint Surg Am 83(6):877–883CrossRefPubMedGoogle Scholar
  11. 11.
    Ho JC, Sabesan VJ, Iannotti JP (2013) Glenoid component retroversion is associated with osteolysis. J Bone Joint Surg Am 95:e82CrossRefPubMedGoogle Scholar
  12. 12.
    Huguet D, Favard L, Lautmann S, Sirvaux F, Kerjean Y, Oudet D (2001) Épidémiologie, imaginerie, classification de l’omarthrose avec rupture massive et non reparable de la coiffe. In: Walch G, Boileau P, Molé D (Hrsg) 2000 shoulder prostheses 2–10 year follow-up. Sauramps medical, Montpellier, S 233–240Google Scholar
  13. 13.
    Iannotti J, Baker J, Rodriguez E, Brems J, Ricchetti E, Mesiha M, Bryan J (2014) Three-dimensional preoperative planning software and a novel information transfer technology improve glenoid component positioning. J Bone Joint Surg Am 96(9):e71CrossRefPubMedGoogle Scholar
  14. 14.
    Iannotti JP, Frangiamore SJ (2012) Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elbow Surg 21(6):765–771CrossRefPubMedGoogle Scholar
  15. 15.
    Knowles NK, Keener JD, Ferreira LM, Athwal GS (2015) Quantification of the position, orientation, and surface area of bone loss in type B2 glenoids. J Shoulder Elbow Surg 24(4):503–510CrossRefPubMedGoogle Scholar
  16. 16.
    Königshausen M, Jettkant B, Sverdlova N, Ehlert C, Gessmann J, Schildhauer TA, Seybold D (2015) Influence of different peg length in glenoid bone loss: a biomechanical analysis regarding primary stability of the glenoid baseplate in reverse shoulder arthroplasty. Technol Health Care 23(6):855–869CrossRefPubMedGoogle Scholar
  17. 17.
    Levigne C, Garret J, Boileau P, Alami G, Favard L, Walch G (2011) Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how? Clin Orthop Relat Res 469:2512–2520CrossRefPubMedGoogle Scholar
  18. 18.
    Maurer A, Fucentese SF, Pfirrmann CW, Wirth SH, Djahangiri A, Jost B, Gerber C (2012) Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg 21:1096–1103CrossRefPubMedGoogle Scholar
  19. 19.
    Mizuno N, Denard PJ, Raiss P, Walch G (2013) Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 95(14):1297–1304CrossRefPubMedGoogle Scholar
  20. 20.
    Neyton L, Walch G, Nové-Josserand L, Edwards TB (2006) Glenoid corticocancellous bone grafting after glenoid component removal in the treatment of glenoid loosening. J Shoulder Elbow Surg 15(2):173–179CrossRefPubMedGoogle Scholar
  21. 21.
    Norris TR, Kelly JD, Humphrey CS (2007) Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Shoulder Elbow Surg 8(1):37–46CrossRefGoogle Scholar
  22. 22.
    Scalise JJ, Iannotti JP (2008) Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res 466(1):139–145CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Wagner E, Houdek MT, Griffith T, Elhassan BT, Sanchez-Sotelo J, Sperling JW, Cofield RH (2015) Glenoid bone-grafting in revision to a reverse total shoulder arthroplasty. J Bone Joint Surg Am 97(20):1653–1660CrossRefPubMedGoogle Scholar
  24. 24.
    Walch G, Moraga C, Young A, Castellanos-Rosas J (2012) Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elbow Surg 21:1526–1533CrossRefPubMedGoogle Scholar
  25. 25.
    Werner BS, Abdelkawi AF, Boehm D, Hudek R, Plumhoff P, Burkhart KJ, Gohlke F (2016) Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems. J Shoulder Elbow Surg.  https://doi.org/10.1016/j.jse.2016.05.015 Google Scholar
  26. 26.
    Werner BS, Böhm D, Abdelkawi A, Gohlke F (2014) Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation. J Shoulder Elbow Surg 23(11):1655–1661CrossRefPubMedGoogle Scholar
  27. 27.
    Williams GR, Iannotti JJP (2007) Options for glenoid bone loss: composites of prosthesis and biologics. J Shoulder Elbow Surg 16(5):267S–262SCrossRefGoogle Scholar
  28. 28.
    Wuisman P, Gohlke F, Witlox A (2003) Allografts in der Rekonstruktion von knöchernen Defekten bei primär malignen Knochentumoren. Orthopäde 32(11):994–1002CrossRefPubMedGoogle Scholar
  29. 29.
    Young A, Walch G, Boileau P, Favard L, Gohlke F, Loew M, Molé D (2011) A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis. J Bone Joint Surg Br 93(2):210–216CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Schulter- und EllenbogenchirurgieRhön-KlinikumBad Neustadt/SaaleDeutschland

Personalised recommendations