Skip to main content

Advertisement

SpringerLink
Log in

Wechseloptionen bei Schulterprothesen

Neue Implantate, Therapiealgorithmus und klinische Ergebnisse

Shoulder prosthesis replacement options

New implants, treatment algorithms and clinical results

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Knöcherne Defektsituationen sind ein häufiges Problem in der Wechselendoprothetik der Schulter und bedingen die Komplexität des Eingriffs. Die humeralen und/oder glenoidalen Defekte können durch aseptische und septische Prothesenlockerungen und im Rahmen des Ausbaus der Prothesenkomponenten entstehen.

Planung

Eine entsprechend differenzierte präoperative Bildgebung erleichtert das Abschätzen des Defektausmaßes und ermöglicht die Planung in Bezug auf die Notwendigkeit eines Knochenaufbaus sowie die Revisionsmöglichkeit mit den zu verwendenden Implantaten. Allerdings muss die Defektgröße intraoperativ nach Komponentenentfernung jeweils neu evaluiert werden und auf einen in der Folge größeren Defekt entsprechend reagiert werden können.

Prothesendesigns

Während glenoidal bevorzugt autologe aber auch allogene Transplantate verwendet werden, gibt es zusehends auch die Möglichkeit der metallischen Augmentation am Glenoid. Am Humerus muss hingegen meist auf Langschaftprothesen ggf. mit Allograftaugmentation zurückgegriffen werden, wobei hier Möglichkeit der Weichteilrefixierung zur Verbesserung der Funktion und Senkung des Luxationsrisikos besteht. Die modernen modularen Prothesendesigns erlauben die Prothesenkonversion unter Belassung knöchern fest integrierter Teilkomponenten am Glenoid oder Schaft. In dieser Übersicht werden die für eine Prothesenrevision notwendige präoperative Diagnostik sowie die humeralen und glenoidalen Techniken des Prothesenwechsels beschrieben.

Abstract

Background

Bony defect situations are a common problem in revision arthroplasty of the shoulder and are the cause of the complexity of the procedure. Aseptic and septic loosening as well as difficult implant removal can result in humeral and/or glenoid bone loss.

Planning

A careful preoperative imaging is needed to estimate the extent of the bony defect and to enable precise planning of the bone reconstruction and the required implants. However, the size of the defect needs to be re-evaluated intraoperatively after removal of the implant components and any larger defects have to be addressed appropriately.

Prosthesis design

While in the glenoid autologous bone grafts and, to a lesser extent, allogenic bone grafts are preferred, metallic augmented implants have recently become available to fill the glenoid bone defect. However, humeral defects are normally addressed with longer revision stems, possibly with allograft augmentation. The soft tissue loss in proximal humeral defects can be addressed with fixation techniques to improve function and reduce the risk of dislocation. Modern modular prosthesis designs allow prosthesis conversion while leaving bony, tightly integrated component parts on the glenoid or shaft. This review describes the preoperative diagnostic steps as well as techniques for revision surgery of the shoulder in the case of bone loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Abbreviations

BIO-RSA:

„Bone increased offset reversed shoulder arthroplasty“

BV:

Bildverstärker

CT:

Computertomographie

PE:

Polyethylen

PSI:

Patientenspezifische Instrumentation

TM:

„Trabecular Metal“

Literatur

  1. Antuna SA, Sperling JW, Cofield RH et al (2001) Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 10:217–224

    Article  CAS  PubMed  Google Scholar 

  2. Boileau P (2016) Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 102:S33–S43

    Article  CAS  PubMed  Google Scholar 

  3. Boileau P, Melis B, Duperron D et al (2013) Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg 22:1359–1370

    Article  PubMed  Google Scholar 

  4. Boileau P, Moineau G, Morin-Salvo N et al (2015) Metal-backed glenoid implant with polyethylene insert is not a viable long-term therapeutic option. J Shoulder Elbow Surg 24:1534–1543

    Article  PubMed  Google Scholar 

  5. Boileau P, Moineau G, Roussanne Y et al (2011) Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res 469:2558–2567

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boileau P, Morin-Salvo N, Gauci MO et al (2017) Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management glenoid bone loss and erosion. J Shoulder Elbow Surg 26(12):2133–2142. https://doi.org/10.1016/j.jse.2017.05.024

    Article  PubMed  Google Scholar 

  7. Budge MD, Moravek JE, Zimel MN et al (2013) Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary? J Shoulder Elbow Surg 22:739–744

    Article  PubMed  Google Scholar 

  8. Chacon A, Virani N, Shannon R et al (2009) Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am 91:119–127

    Article  PubMed  Google Scholar 

  9. Cheung E, Willis M, Walker M et al (2011) Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 19:439–449

    Article  PubMed  Google Scholar 

  10. Day JS, Lau E, Ong KL et al (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 19:1115–1120

    Article  PubMed  Google Scholar 

  11. Flury MP, Frey P, Goldhahn J et al (2011) Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results. Int Orthop 35:53–60

    Article  PubMed  Google Scholar 

  12. Gohlke F, Rolf O (2007) Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol 19:185–208

    Article  PubMed  Google Scholar 

  13. Guery J, Favard L, Sirveaux F et al (2006) Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 88:1742–1747

    Article  PubMed  Google Scholar 

  14. Hartel BP, Alta TD, Sewnath ME et al (2015) Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery. Int J Shoulder Surg 9:69–73

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hendel MD, Bryan JA, Barsoum WK et al (2012) Comparison of patient-specific instruments with standard surgical instruments in determining glenoid component position: a randomized prospective clinical trial. J Bone Joint Surg Am 94:2167–2175

    Article  PubMed  Google Scholar 

  16. Holcomb JO, Cuff D, Petersen SA et al (2009) Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg 18:717–723

    Article  PubMed  Google Scholar 

  17. Iannotti J, Baker J, Rodriguez E et al (2014) Three-dimensional preoperative planning software and a novel information transfer technology improve glenoid component positioning. J Bone Joint Surg Am 96:e71

    Article  PubMed  Google Scholar 

  18. Jones RB, Wright TW, Roche CP (2015) Bone grafting the glenoid versus use of augmented glenoid baseplates with reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013) 73(Suppl 1):S129–S135

    Google Scholar 

  19. Jones RB, Wright TW, Zuckerman JD (2016) Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg 25:1425–1432

    Article  PubMed  Google Scholar 

  20. Konigshausen M, Jettkant B, Sverdlova N et al (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 23:855–869

    Article  CAS  PubMed  Google Scholar 

  21. Konigshausen M, Sverdlova N, Ehlert C et al (2017) Bone grafting in oblique versus prepared rectangular uncontained glenoid defects in reversed shoulder arthroplasty. A biomechanical comparison. Clin Biomech (Bristol, Avon) 50:7–15

    Article  CAS  Google Scholar 

  22. Martin SD, Zurakowski D, Thornhill TS (2005) Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes. J Bone Joint Surg Am 87:1284–1292

    PubMed  Google Scholar 

  23. Moroder P, Gerhardt C, Renz N et al (2016) Diagnostik und Management des Endoprotheseninfekts am Schultergelenk. Obere Extremität 11:78–87

    Article  Google Scholar 

  24. Norris TR, Kelly JD 2nd (2007) Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Shoulder Elbow Surg 8:37–46

    Article  Google Scholar 

  25. Sanchez-Sotelo J, Wagner ER, Sim FH et al (2017) Allograft-prosthetic composite reconstruction for massive proximal humeral bone loss in reverse shoulder arthroplasty. J Bone Joint Surg Am 99:2069–2076

    Article  PubMed  Google Scholar 

  26. Seybold D, Geßmann J, Königshausen M et al (2016) Glenoidale und humerale Revision nach Schulterendoprothese. Obere Extremität 11:210–217

    Article  Google Scholar 

  27. Stephens SP, Paisley KC, Giveans MR et al (2015) The effect of proximal humeral bone loss on revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg 24:1519–1526

    Article  PubMed  Google Scholar 

  28. Trappey GJT, O’connor DP, Edwards TB (2011) What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop Relat Res 469:2505–2511

    Article  PubMed  Google Scholar 

  29. Villacis D, Sivasundaram L, Pannell WC et al (2016) Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years. J Shoulder Elbow Surg 25:927–935

    Article  PubMed  Google Scholar 

  30. Werner BS, Abdelkawi AF, Boehm D et al (2017) Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems. J Shoulder Elbow Surg 26:273–278

    Article  PubMed  Google Scholar 

  31. Werner BS, Abdelkawi AF, Boehm D et al (2016) Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems. J Shoulder Elbow Surg 26(2):273–278. https://doi.org/10.1016/j.jse.2016.05.015

    Article  PubMed  Google Scholar 

  32. Werner BS, Boehm D, Gohlke F (2013) Revision to reverse shoulder arthroplasty with retention of the humeral component. Acta Orthop 84:473–478

    Article  PubMed  PubMed Central  Google Scholar 

  33. Williams GR Jr., Iannotti JP (2007) Options for glenoid bone loss: composites of prosthetics and biologics. J Shoulder Elbow Surg 16:S267–S272

    Article  PubMed  Google Scholar 

  34. Zumstein MA, Pinedo M, Old J et al (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20:146–157

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    D. Seybold, T. A. Schildhauer & J. Geßmann

Authors
  1. D. Seybold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. A. Schildhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Geßmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Seybold.

Ethics declarations

Interessenkonflikt

D. Seybold, T. A. Schildhauer und J. Geßmann geben an, dass kein Interessenkonflikt besteht.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seybold, D., Schildhauer, T.A. & Geßmann, J. Wechseloptionen bei Schulterprothesen. Orthopäde 47, 398–409 (2018). https://doi.org/10.1007/s00132-018-3549-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-018-3549-0

Schlüsselwörter

Keywords

Search

Navigation