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Schulterendoprothese

Bis wann anatomisch, ab wann invers?

Shoulder arthroplasty

How far can we push anatomical joint replacement, what are the indications for reverse?

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Anatomischer (TSA) und inverser (RSA) Schultergelenkersatz haben sich parallel entwickelt und ihre eigenen spezifischen Indikationsfelder. Der klinische Erfolg spiegelt sich in den steigenden Implantationszahlen der letzten Dekade wider. Die inverse Schulterendoprothese ist in gewisser Hinsicht der Endpunkt der endoprothetischen Versorgung. Revisionsoperationen münden häufig in eine inverse Schulterendoprothese. Es existiert eine Reihe von überlappenden Indikationen, bei denen sowohl anatomische als auch inverse Endoprothesen zum Einsatz kommen können. Viele Hersteller bieten mittlerweile modulare Plattformsysteme, die eine Konversion von TSA in RSA und Teilwechsel unter Belassung funktionierender Implantatkomponenten ermöglichen, und tragen damit der klinischen Realität Rechnung. Da Wechseloperationen von inversen Schulterendoprothesen aufwändig, schwierig und mit limitierten funktionellen Aussichten für den Patienten verbunden sind, sollte die Verwendung anatomischer Endoprothesen insbesondere bei jüngeren Patienten bzw. gelenkerhaltende Eingriffe so weit wie möglich und sinnvoll ausgereizt werden. Die genauen Grenzen in den überlappenden Bereichen der Grauzone sind oftmals nicht genau definiert und können sich in der Zukunft mit dem besseren Verständnis der Pathoanatomie und der Entwicklung neuer Implantate und Techniken weiter verschieben. Ziel der Arbeit ist es, einen Überblick über den gegenwärtigen Stand des Wissens zu geben und dem Leser eine Unterstützung bei der Entscheidungsfindung im klinischen Alltag zu bieten.

Abstract

Total shoulder arthroplasty (TSA) with anatomical implants and reverse shoulder arthroplasty (RSA) have developed in parallel and each has its own specific field of application. The clinical success is reflected in the increasing number of implantations in the last decades. Reverse shoulder implants are in certain respects the endpoint in endoprosthetic shoulder arthroplasty. Revision surgery often leads to the use of reverse shoulder implants. There are a number of overlapping indications in which both anatomical as well as reverse implants can be used. Many manufacturers nowadays offer modular platform systems that allow a conversion of TSA to RSA and partial conversion with preservation of functioning implant components to meet this demand in the reality of clinical practice. Revision arthroplasty of reverse shoulder prostheses is extensive, costly, difficult and often accompanied by reduced functional outcome for the patient. Therefore, the use of anatomical implants or joint-preserving operations should be pushed as much as reasonably possible, especially for younger patients. The exact demarcations in the overlapping regions of the grey zone are often not clearly defined and are likely to shift further in the future with a better understanding of the pathoanatomy and the further perfection of implants and techniques. The aim of this article is to provide an overview of the current state of knowledge in the field and to provide the reader with support in decision-making in the clinical routine.

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Literatur

  1. Antonios T, Bakti N, Nzeako O et al (2019) Outcomes following fixation for proximal humeral fractures. J Clin Orthop Trauma 10:468–473

    Article  PubMed  PubMed Central  Google Scholar 

  2. Austin DC, Torchia MT, Cozzolino NH et al (2019) Decreased Reoperations and improved outcomes with reverse total shoulder arthroplasty in comparison to hemiarthroplasty for geriatric proximal humerus fractures: a systematic review and meta-analysis. J Orthop Trauma 33:49–57

    Article  PubMed  Google Scholar 

  3. Ballas R, Teissier P, Teissier J (2016) Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy. International Orthopaedics (SICOT) 40:1473–1479

    Article  Google Scholar 

  4. Beks RB, Ochen Y, Frima H et al (2018) Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg 27:1526–1534

    Article  PubMed  Google Scholar 

  5. Boileau P, Walch G (1999) Anatomical study of the proximal humerus: surgical technique considerations and prosthetic design rationale. In: Walch G, Boileau P (Hrsg) Shoulder Arthroplasty. Springer, Berlin, Heidelberg, New York

    Google Scholar 

  6. Boileau P, Trojani C, Walch G et al (2001) Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elbow Surg 10:299–308

    Article  CAS  PubMed  Google Scholar 

  7. Boyle MJ, Youn SM, Frampton CM et al (2013) Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg 22:32–37

    Article  PubMed  Google Scholar 

  8. Chin PC, Hachadorian ME, Pulido PA et al (2015) Outcomes of anatomic shoulder arthroplasty in primary osteoarthritis in type B glenoids. J Shoulder Elbow Surg 24:1888–1893

    Article  PubMed  Google Scholar 

  9. Collin P, Herve A, Walch G et al (2019) Mid-term results of reverse shoulder arthroplasty for glenohumeral osteoarthritis with posterior glenoid deficiency and humeral subluxation. J Shoulder Elbow Surg 28:2023–2030

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Diaz JA, Cohen SB, Warren RF et al (2003) Arthrodesis as a salvage procedure for recurrent instability of the shoulder. J Shoulder Elbow Surg 12:237–241

    Article  PubMed  Google Scholar 

  12. Dimmen S, Madsen JE (2007) Long-term outcome of shoulder arthrodesis performed with plate fixation: 18 patients examined after 3–15 years. Acta Orthop 78:827–833

    Article  PubMed  Google Scholar 

  13. Ernstbrunner L, Werthel JD, Wagner E et al (2017) Glenoid bone grafting in primary reverse total shoulder arthroplasty. J Shoulder Elbow Surg 26:1441–1447

    Article  PubMed  Google Scholar 

  14. Garofalo R, Flanagin B, Castagna A et al (2015) Reverse shoulder arthroplasty for proximal humerus fracture using a dedicated stem: radiological outcomes at a minimum 2 years of follow-up-case series. J Orthop Surg Res 10:129

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gerber C, Costouros JG, Sukthankar A et al (2009) Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg 18:505–510

    Article  PubMed  Google Scholar 

  16. Gohlke F, Werner B (2017) Humeral and glenoid bone loss in shoulder arthroplasty : Classification and treatment principles. Orthopäde 46:1008–1014

    Article  CAS  PubMed  Google Scholar 

  17. Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68

    Article  CAS  PubMed  Google Scholar 

  18. Harmsen S, Casagrande D, Norris T (2017) “Shaped” humeral head autograft reverse shoulder arthroplasty : Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type). Orthopäde 46:1045–1054

    Article  CAS  PubMed  Google Scholar 

  19. Hasler A, Fornaciari P, Jungwirth-Weinberger A et al (2019) Reverse shoulder arthroplasty in the treatment of glenohumeral instability. J Shoulder Elbow Surg 28:1587–1594

    Article  PubMed  Google Scholar 

  20. Iannotti JP, Norris TR (2003) Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 85:251–258

    Article  PubMed  Google Scholar 

  21. Irlenbusch U, Rott O, Irlenbusch L (2018) Indication, technique and long-term results after shoulder arthrodesis performed with plate fixation. Z Orthop Unfall 156:53–61

    Article  PubMed  Google Scholar 

  22. 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 

  23. Kircher J (2019) Knorpelschaden und Arthrose des Glenohumeralgelenks. In: Orthopädie und Unfallchirurgie. Springer, Berlin, Heidelberg, S 1–18

    Google Scholar 

  24. Kircher J, Morhard M, Magosch P et al (2010) How much are radiological parameters related to clinical symptoms and function in osteoarthritis of the shoulder? Int Orthop 34:677–681

    Article  PubMed  Google Scholar 

  25. Kircher J, Junker M, Weber J (2019) Revision der instabilen Schulterprothese und Komplikationen. Orthopäd Unfallchir Prax 8:329–335

    Google Scholar 

  26. Kircher J, Junker M, Hedtmann A (2020) Gelenkerhaltende Therapie bei irreparablen Rotatorenmanschettendefekten. Orthopäd Unfallchir Up2date 15:1–14

    Google Scholar 

  27. Kurowicki J, Triplet JJ, Momoh E et al (2016) Reverse shoulder prosthesis in the treatment of locked anterior shoulders: a comparison with classic reverse shoulder indications. J Shoulder Elbow Surg 25:1954–1960

    Article  PubMed  Google Scholar 

  28. Malhas AM, Granville-Chapman J, Robinson PM et al (2018) Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal-backed prosthesis: the first 45 sequential cases at a minimum of two years’ follow-up. Bone Joint J 100-B:1609–1617

    Article  CAS  PubMed  Google Scholar 

  29. Mcfarland EG, Huri G, Hyun YS et al (2016) Reverse total shoulder Arthroplasty without bone-grafting for severe Glenoid Bone loss in patients with osteoarthritis and intact rotator cuff. J Bone Joint Surg Am 98:1801–1807

    Article  PubMed  Google Scholar 

  30. Mizuno N, Denard PJ, Raiss P et al (2013) Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 95:1297–1304

    Article  PubMed  Google Scholar 

  31. Moineau G, Mcclelland WB Jr., Trojani C et al (2012) Prognostic factors and limitations of anatomic shoulder arthroplasty for the treatment of posttraumatic cephalic collapse or necrosis (type‑1 proximal humeral fracture sequelae). J Bone Joint Surg Am 94:2186–2194

    Article  PubMed  Google Scholar 

  32. Neer CS, Brown TH Jr., Mclaughlin HL (1953) Fracture of the neck of the humerus with dislocation of the head fragment. Am J Surg 85:252–258

    Article  CAS  PubMed  Google Scholar 

  33. Neer CS 2nd, Craig EV, Fukuda H (1983) Cuff-tear arthropathy. J Bone Joint Surg Am 65:1232–1244

    Article  PubMed  Google Scholar 

  34. Ohly B, Magosch P, Kircher J et al (2019) Revisionen nach Schulterendoprothetik. Obere Extrem 14:179–188

    Article  Google Scholar 

  35. Raiss P, Zeifang F, Pons-Villanueva J et al (2014) Reverse arthroplasty for osteoarthritis and rotator cuff deficiency after previous surgery for recurrent anterior shoulder instability. International Orthopaedics (SICOT) 38:1407–1413

    Article  Google Scholar 

  36. Statz JM, Schoch BS, Sanchez-Sotelo J et al (2017) Shoulder arthroplasty for locked anterior shoulder dislocation: a role for the reversed design. International Orthopaedics (SICOT) 41:1227–1234

    Article  Google Scholar 

  37. Thangarajah T, Higgs D, Bayley JI et al (2017) Glenohumeral arthrodesis for recurrent types II and III shoulder instability. J Shoulder Elbow Surg 26:687–691

    Article  PubMed  Google Scholar 

  38. Walch G, Moraga C, Young A et al (2012) Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elbow Surg 21:1526–1533

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. ATOS Klinik Fleetinsel Hamburg, Admiralitätstraße 3–4, 20459, Hamburg, Deutschland

    Jörn Kircher

  2. Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland

    Jörn Kircher

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Correspondence to Jörn Kircher.

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J. Kircher ist beratender Consultant der Firma LimaCorporate S.p.A.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kircher, J. Schulterendoprothese. Arthroskopie 33, 370–377 (2020). https://doi.org/10.1007/s00142-020-00394-y

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  • DOI: https://doi.org/10.1007/s00142-020-00394-y

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