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Der Orthopäde

, Volume 47, Issue 5, pp 377–382 | Cite as

Optionen der gelenkerhaltenden operativen Omarthrosetherapie

  • Marc-Frederic Pastor
  • Tomas Smith
  • Mathias WellmannEmail author
Leitthema

Zusammenfassung

Hintergrund

Die Therapie der Omarthrose stellt bei jüngeren Patienten mit einem hohen Aktivitätsanspruch eine große Herausforderung dar, da bei diesen Patienten die endoprothetische Versorgung häufig unbefriedigende Ergebnisse bei begrenzten Standzeiten erzielt.

Ziel der Arbeit

Das Ziel der Studie war es, die gelenkerhaltenden Therapien bei der Omarthrose herauszuarbeiten.

Material und Methoden

Für diese Arbeit wurde eine selektive Literaturrecherche durchgeführt.

Ergebnisse

Für die gelenkerhaltende Therapie der Omarthrose stehen mehrere Optionen zur Verfügung. Neben dem arthroskopischen Débridement mit Behandlung von Begleitpathologien stehen noch das CAM-Prozedere (CAM: „comprehensive arthroscopic management“) nach Millett sowie knorpelinduktive Verfahren bei umschriebenen humeralen Chondralläsionen zur Verfügung. Für alle Therapieoptionen werden ein verbessertes Bewegungsausmaß und eine Schmerzreduktion beschrieben. Eine Gelenkspaltweite <2 mm, bipolare Knorpelschäden sowie das Alter werden als Risikofaktoren für das Versagen der Therapien beschrieben.

Diskussion

Für das arthroskopische Débridement sind kurz- bis mittelfristige Ergebnisse beschrieben, jedoch fehlt es an langfristigen Ergebnissen sowie qualitativ hochwertigen Studien, um eine klare Empfehlung auszusprechen. Das CAM-Prozedere sowie die Interposition eines Allografts sind anspruchsvolle Verfahren, die erfahrenen Arthroskopeuren vorbehalten sein sollten. Diese Therapien stellen eine Option für jüngere Patienten bei individueller Entscheidung und realistischer Erwartungshaltung dar.

Schlüsselwörter

Arthroskopie Allograft Arthrose Débridement Glenohumeralgelenk 

Abkürzungen

ASES

American Shoulder and Elbow Surgeons

CAM

„Comprehensive arthroscopic management“

MGHL

Mittleres glenohumerales Ligament

NSAR

Nichtsteroidale Antirheumatika

SSP

Supraspinatussehne

VAS

Visuelle Analogskala

Options in joint-preserving surgical treatment of osteoarthritis

Abstract

Background

The treatment of glenohumeral arthritis represents a major challenge in highly active younger patients. In these patients, an endoprosthetic treatment often achieves only unsatisfactory results with a limited lifetime of the implant.

Objectives

The aim of the study was to identify joint-preserving therapies for glenohumeral arthritis.

Materials and methods

For this study, an extensive and selective literature search was performed.

Results

There are several options available for joint-preserving treatment of glenohumeral arthritis. In addition to arthroscopic debridement with treatment of concomitant pathologies, CAM procedures (CAM: comprehensive arthroscopic management) according to Millett, as well as the interposition of allografts are other options. For all therapy options, an improved range of motion and pain reduction is described. A joint gap of <2 mm, bipolar cartilage lesions and age are described as risk factors for failure of the therapies.

Discussion

Short and mid-term results have been described for arthroscopic debridement, but there are no long-term and high-quality studies to enable us to make clear recommendations. The CAM procedure and the interposition of an allograft are demanding procedures that should be reserved for experienced arthroscopists. The therapies are an option for younger patients in accordance with individual decisions and realistic expectations.

Keywords

Arthroscopic surgery Allografts Polyarthritis Debridement Glenohumeral joint 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M.-F. Pastor, T. Smith und M. Wellmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Marc-Frederic Pastor
    • 1
  • Tomas Smith
    • 1
  • Mathias Wellmann
    • 1
    Email author
  1. 1.Orthopädische KlinikMedizinische Hochschule Hannover im Diakovere AnnastiftHannoverDeutschland

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