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Anatomische Schulterprothese bei Omarthrose

Indikation, aktuelle Implantate, klinische Ergebnisse

Anatomical total shoulder replacement in glenohumeral osteoarthritis

Indications, current implants, and clinical results

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Zusammenfassung

Implantatformen

In den letzten 50 Jahren ist es im Bereich der Schulterendoprothetik zu einer rasanten Entwicklung der Implantate gekommen. Monoblockimplantate in wenigen Größen wurden ersetzt durch modulare Systeme, welche eine individuelle Anpassung sowohl des Schafts als auch der Kopfkalotte auf die anatomischen Voraussetzungen des Patienten ermöglichen. Darüber hinaus sind schaftfreie und Kurzschaftimplantate erhältlich, die – insbesondere in posttraumatischen Fällen – die primäre Implantation, aber auch einen späteren Prothesenwechsel erheblich erleichtern können. Auch im Pfannenbereich sind neben der Weiterentwicklung der zementierten PE-Glenoide auch zementfreie modulare Implantate erhältlich, welche im Falle eines sekundären Versagens der Rotatorenmanschette eine Konversion der Pfanne auf eine inverse Prothese ohne Wechsel des „metal-backs“ ermöglichen.

Ergebnisse

Mittlerweile erreichen die Standzeiten und Überlebensraten der anatomischen Schulterprothesen vergleichbare Ergebnisse zu denen der Knie- und Hüftprothesen, bei guten bis exzellenten klinischen Ergebnissen auch im Langzeitverlauf. Der Schlüssel für ein erfolgreiches Operationsergebnis ist neben der Erfahrung des Operateurs die richtige und vor allem auch nicht zu späte Indikationsstellung. Massive Muskel- und Weichteilkontrakturen sowie ausgedehnter konzentrischer oder exzentrischer Pfannenabrieb können einen maßgeblichen Einfluss sowohl auf die erreichbare Schulterfunktion und Stabilität als auch auf die adäquate Fixation der Gelenkpfanne haben.

Abstract

Implant designs

Within the last 50 years, implants for shoulder replacement have developed rapidly. Monobloc-stems in few sizes were changed to modular implant systems that allow for an individual adaption of the stem, as well as adaption of the humeral head component according to the specific anatomic situation of the patient. Moreover, stemless und short stem implants are available, which may highly simplify primary implantation, especially in posttraumatic cases as well as in revision cases with a need for removal or change of the implants. Concerning the glenoid component, cemented PE-inlays were further modified to increase long-term survival rates. Moreover, cement-free modular “metal-backs” allow for a conversion to a reverse total shoulder arthroplasty without removal of the “metal back” component.

Results

Long-term survival rates of total shoulder arthroplasties achieve comparable survival rates to knee and hip arthroplasties with good to excellent clinical long-term results. In addition to an experienced surgeon, the key to a successful surgical result is the correct and timely indication, as massive contractures of the soft tissues as well as excessive abrasion of the glenoid bone may significantly impair the functional results.

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Abbreviations

PE:

Polyethylen

TEP:

Totalendoprothese

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  1. Sporthopaedicum Berlin, Bismarckstraße 45–47, 10627, Berlin, Deutschland

    O. Lorbach

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Lorbach, O. Anatomische Schulterprothese bei Omarthrose. Orthopäde 47, 383–389 (2018). https://doi.org/10.1007/s00132-018-3544-5

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