Zusammenfassung
Der Schultergelenkersatz bei jungen Patienten <50 (55) Jahre stellt hinsichtlich Funktion und Endoprothesenstandzeit eine große Herausforderung dar. Diverse Studien zeigen, dass gerade bei jungen Patienten Schultertotalendoprothesen (Schulter-TEPs) im Vergleich zu Hemiendoprothesen zu besseren klinischen Resultaten hinsichtlich Schmerzreduktion, Funktion und längeren Standzeiten führen. Insbesondere die gängigen Humerusersatzköpfe aus Cobalt-Chrom (CoCr) können bei den Hemiendoprothesen zu einem frühzeitigen Glenoidverschleiß mit medialer Protrusion sowie konsekutiven Schmerzen und Funktionsverlust führen. Ob neue Implantatmaterialien, wie z. B. Pyrocarbon, Aluminiumoxid-Keramik (AL2O3) oder Polycarbonat-Urethan (PCU), hier den Glenoidverbrauch reduzieren und somit eine Verbesserung der Funktion und Standzeiten erbringen, konnte gegenwärtig zwar in biomechanischen Studien gezeigt, in klinischen Studien jedoch noch nicht eindeutig bewiesen werden. Bereits eine einzige Ablösung der Subskapularissehne (SSC) im Rahmen einer Arthrotomie und insbesondere wiederholte Arthrotomien führen zu SSC-Insuffizienzen, weshalb schon bei der Erstimplantation langfristig gedacht werden sollte. Dies stellt fokale Gelenkersatzoperationen bei größeren Knorpelschäden in Frage, da hier Revisionsoperationen zu erwarten sind. Neue anatomisch-elliptisch geformte Humerusimplantate sowie auch zementierte Inlay- oder wenig auftragende zementfrei einwachsende metallische Glenoidimplantate ohne glenohumerale Offset-Vergrößerung bei Schulter-TEPs erbringen möglicherweise eine Verbesserung der Endoprothesenstandzeiten und Funktion gerade bei jungen aktiven Patienten. Langzeitstudien hierzu stehen allerdings noch aus.
Abstract
Shoulder joint replacement in young patients <50 (55) years old is a great challenge with respect to shoulder function and prosthesis survival, as both are limited. Several studies have shown that total shoulder arthroplasty leads to better clinical results compared to partial endoprostheses concerning pain relief, shoulder function and implant survival, especially in young patients. The cobalt chrome (CoCr) implants commonly used for humeral head replacement in hemiarthroplasty in particular, can cause premature attrition of the glenoid cartilage and bone with medial protrusion and subsequent pain and loss of function. Whether new implant materials, such as as pyrocarbon, aluminium oxide ceramics (Al2O3) or polycarbonate urethane (PCU) can reduce glenoid attrition with a subsequent improvement of function and increased survival of the implant, has been proven in biomechanical studies but not yet in clinical studies. Even a single detachment of the subscapularis tendon during arthrotomy and especially with repeated arthrotomy leads to subscapularis tendon insufficiency. Therefore, even during the primary implantation long-term consideration should be given to partial joint replacements, which are questionable in larger chondral lesions because revisions are to be expected. New elliptical anatomically designed humeral implants and also cemented inlay components and low-profile cementless metallic glenoid implants with a good bony ingrowth without glenohumeral offset enlargement in total shoulder replacement could lead to longer prostheses survival and better shoulder function, particularly in young active patients; however, long-term results of clinical studies are currently not available.
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Literatur
Ajdari N, Tempelaere C, Masouleh MI et al (2020) Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.09.041
Anderl W, Kriegleder B, Neumaier M et al (2015) Arthroscopic partial shoulder resurfacing. Knee Surg Sports Traumatol Arthrosc 23:1563–1570
Barret H, Gauci MO, Langlais T et al (2020) Pyrocarbon interposition shoulder arthroplasty in young arthritic patients: a prospective observational study. J Shoulder Elbow Surg 29:e1–e10
Bartelt R, Sperling JW, Schleck CD et al (2011) Shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis. J Shoulder Elbow Surg 20:123–130
Baumgarten KM, Osborn R, Schweinle WE Jr. et al (2018) The influence of anatomic total shoulder arthroplasty using a subscapularis tenotomy on shoulder strength. J Shoulder Elbow Surg 27:82–89
Brewley EE Jr., Christmas KN, Gorman RA 2nd et al (2020) Defining the younger patient: age as a predictive factor for outcomes in shoulder arthroplasty. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.09.016
Cvetanovich GL, Naylor AJ, O’brien MC et al (2019) Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.10.003
Denard PJ, Walch G (2013) Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elbow Surg 22:1589–1598
Garret J, Harly E, Le Huec JC et al (2019) Pyrolytic carbon humeral head in hemi-shoulder arthroplasty: preliminary results at 2‑year follow-up. JSES Open Access 3:37–42
Gerber C, Schneeberger AG, Beck M et al (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76:371–380
Iannotti JP, Gabriel JP, Schneck SL et al (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am 74:491–500
Neyton L, Kirsch JM, Collotte P et al (2019) Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under. J Shoulder Elbow Surg 28:1666–1673
Patzer T, Ziskoven C, Krauspe R (2013) Surgical approach to the shoulder. Lesser tuberosity osteotomy. Orthopade 42:356–358, 360–353
Rasmussen JV, Hole R, Metlie T et al (2018) Anatomical total shoulder arthroplasty used for glenohumeral osteoarthritis has higher survival rates than hemiarthroplasty: a Nordic registry-based study. Osteoarthritis Cartilage 26:659–665
Scheibel M, Habermeyer P (2008) Subscapularis dysfunction following anterior surgical approaches to the shoulder. J Shoulder Elbow Surg 17:671–683
Scheibel M, Nikulka C, Dick A et al (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35:1153–1161
Scheibel M, Tsynman A, Magosch P et al (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34:1586–1593
Schoch BS, Barlow JD, Schleck C et al (2016) Shoulder arthroplasty for post-traumatic osteonecrosis of the humeral head. J Shoulder Elbow Surg 25:406–412
Sperling JW, Cofield RH, Rowland CM (2004) Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger. J Shoulder Elbow Surg 13:604–613
Wagner ER, Houdek MT, Schleck CD et al (2017) The role age plays in the outcomes and complications of shoulder arthroplasty. J Shoulder Elbow Surg 26:1573–1580
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Patzer, T. Schultergelenkersatz bei jungen Patienten. Arthroskopie 33, 336–347 (2020). https://doi.org/10.1007/s00142-020-00383-1
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DOI: https://doi.org/10.1007/s00142-020-00383-1