Skip to main content

Advertisement

SpringerLink
Log in

Indikationsspezifische mittelfristige Ergebnisse der anatomischen Kurzschaft-Schulterprothese

Midterm results of a stemless shoulder prosthesis for different indications

  • Originalarbeit
  • Published:
Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Mit der anatomischen Kurzschaft-Schulterprothese steht ein neues Konzept der Schulterendoprothetik für die klinische Anwendung zur Verfügung. Es liegen bisher wenig publizierte Daten über die Erfahrungen mit diesem Prothesentyp vor. Ziel dieser Studie war die Evaluation der indikationsspezifischen mittelfristigen klinischen und radiologischen Ergebnisse dieses Implantates.

Material und Methoden

Bei 86 Patienten (31 männlich/55 weiblich, Alter 65,4 ± 8,7 Jahre) wurden vor und nach Implantation der Kurzschaft-Schulterprothese T.E.S.S.® bei einem mittleren Nachuntersuchungszeitraum von 31 ± 4 Monaten (Spannweite 24–47 Monate) der Constant Murley Score (CMS), der Disabilities of Arm and Shoulder, and Hand (DASH)-Score, der aktive Bewegungsumfang (Abduktion, Anteversion, Außenrotation) sowie der radiologische Verlauf analysiert.

Ergebnisse

Der CMS verbesserte sich insgesamt signifikant (p < 0,001) von 36,2 ± 9,5 Punkte auf 66,0 ± 14,4 Punkte postoperativ, wobei erwartungsgemäß deutliche indikationsspezifische Unterschiede nachweisbar waren (CMS postoperativ: primäre Omarthrose 73,3 ± 11,4 Punkte, posttraumatische Omarthrose 56,6 ± 12,8 Punkte, Humeruskopfnekrose 62,7 ± 9,8 Punkte, rheumatoide Arthritis 50,2 ± 11,0 Punkte, Rotatorenmanschetten-Defektarthropathie 44,7 ± 3,7 Punkte). Während sich die Schmerzsymptomatik gruppenunabhängig signifikant verbesserte, waren die besten funktionellen Ergebnisse bei primärer Omarthrose und Humeruskopfnekrose zu verzeichnen.

Schlussfolgerungen

Mit der anatomischen Kurzschaft-Schulterprothese können je nach Indikationsstellung gute bis akzeptable klinische Resultate erzielt werden, die im mittelfristigen Nachuntersuchungszeitraum mit denen modularer anatomischer Schaft-Prothesensysteme vergleichbar sind.

Abstract

Background

The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. To date, only few studies have investigated the results of this prosthesis. The aim of this study was to investigate the clinical and radiological midterm results of this implant with respect to different indications.

Materials and Methods

The Constant Murley score (CMS), the disabilities of the arm, shoulder, and hand (DASH) score, active range of motion (abduction, anteversion, external rotation) and radiological results were examined in 86 patients (31 male/55 female, age 65.4 ± 8.7 years) with the TESS® stemless shoulder prosthesis. The average follow-up time was 31 ± 4 months.

Results

The overall mean CMS improved significant (p < 0.001) from 36.2 ± 9.5 points preoperatively to 66.0 ± 14.4 points after surgery and, as suspected, shows significant differences between the various patient groups (CMS after surgery: primary omarthrosis 73.3 ± 11.4 points, posttraumatic omarthrosis 56.6 ± 12.8 points, humeral head necrosis 62.7 ± 9.8 points, rheumatoid arthritis 50.2 ± 11.0 points, rotator cuff tear arthropathy 44.7 ± 3.7 points). Regarding pain relief, there were no significant differences within the patient groups. In contrast, the functional results were significantly better in patient with primary omarthrosis and humerus head necrosis as compared to the other indications.

Conclusions

Depending on the indication, the use of stemless shoulder prostheses leads to good results that are comparable to those of conventional anatomic shoulder prostheses at mid-term follow-up.

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

Literatur

  1. Antuna SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17(2):202–209

    Article  PubMed  Google Scholar 

  2. Berth A, Pap G (2007) Konzept und frühfunktionelle Ergebnisse eines neuen Doppelexzenter-Schulter-Prothesensystems. Obere Extremität 2(2):73–80

    Article  Google Scholar 

  3. Berth A, Pap G (2008) Hemi- versus bipolar shoulder arthroplasty for chronic rotator cuff arthropathy. Int Orthop 32(6):735–740

    Article  PubMed  Google Scholar 

  4. Bohsali KI, Wirth MA, Rockwood CA Jr (2006) Complications of total shoulder arthroplasty. J Bone Joint Surg Am 88(10):2279–2292

    Article  PubMed  Google Scholar 

  5. Boileau P, Chuinard C, Le Huec JC et al (2006) Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res 442:121–130

    Article  PubMed  Google Scholar 

  6. Boileau P, Sinnerton RJ, Chuinard C, Walch G (2006) Arthroplasty of the shoulder. J Bone Joint Surg Br 88(5):562–575

    Article  PubMed  CAS  Google Scholar 

  7. 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(4):299–308

    Article  PubMed  CAS  Google Scholar 

  8. Boileau P, Walch G (1997) The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br 79(5):857–865

    Article  PubMed  CAS  Google Scholar 

  9. Brunner U, Kohler S (2007) Shoulder arthroplasty for treatment of the sequelae of proximal humerus fractures. Orthopäde 36(11):1037–1049

    Article  PubMed  CAS  Google Scholar 

  10. Bryant D, Litchfield R, Sandow M et al (2005) A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am 87(9):1947–1956

    Article  PubMed  Google Scholar 

  11. Chin PY, Sperling JW, Cofield RH, Schleck C (2006) Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg 15(1):19–22

    Article  PubMed  Google Scholar 

  12. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res (214):160–164

    Google Scholar 

  13. Cruess RL (1976) Steroid-induced avascular necrosis of the head of the humerus. Natural history and management. J Bone Joint Surg Br 58(3):313–317

    PubMed  CAS  Google Scholar 

  14. Farng E, Zingmond D, Krenek L, Soohoo NF (2011) Factors predicting complication rates after primary shoulder arthroplasty. J Shoulder Elbow Surg 20(4):557–563

    Article  PubMed  Google Scholar 

  15. Fuerst M, Fink B, Ruther W (2007) The DUROM cup humeral surface replacement in patients with rheumatoid arthritis. J Bone Joint Surg Am 89(8):1756–1762

    Article  PubMed  Google Scholar 

  16. Geurts GF, Riet RP van, Jansen N, Declercq G (2010) Placement of the stemless humeral component in the Total Evolutive Shoulder System (TESS). Tech Hand Up Extrem Surg 14(4):214–217

    Article  PubMed  Google Scholar 

  17. Habermeyer P (1995) Alloarthroplastik des Schultergelenkes. In: Habermeyer P, Schweiberer L (Hrsg) Schulterchirurgie, Urban & Schwarzenberg, München, S 305–325

  18. Hedtmann A, Werner A (2007) Shoulder arthroplasty in rheumatoid arthritis. Orthopäde 36(11):1050–1061

    Article  PubMed  CAS  Google Scholar 

  19. Heers G, Grifka J, An KN (2001) Biomechanical considerations on shoulder joint prosthesis implantation. Orthopäde 30(6):346–353

    Article  PubMed  CAS  Google Scholar 

  20. Hettrich CM, Weldon E III, Boorman RS et al (2004) Preoperative factors associated with improvements in shoulder function after humeral hemiarthroplasty. J Bone Joint Surg Am 86-A(7):1446–1451

    Google Scholar 

  21. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608

    Article  PubMed  CAS  Google Scholar 

  22. Huguet D, Declercq G, Rio B et al (2010) Results of a new stemless shoulder prosthesis: Radiologic proof of maintained fixation and stability after a minimum of three years‘ follow-up. J Shoulder Elbow Surg 19(6):847–852

    Article  PubMed  Google Scholar 

  23. 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(4):491–500

    PubMed  CAS  Google Scholar 

  24. Iannotti JP, Spencer EE, Winter U et al (2005) Prosthetic positioning in total shoulder arthroplasty. J Shoulder Elbow Surg 14(1 Suppl S):111S–121S

    Article  PubMed  Google Scholar 

  25. Irlenbusch U, Blatter G, Gebhardt K et al (2010) Prospective study of double-eccentric hemi shoulder arthroplasty in different aetiologies: midterm results. Int Orthop 35(7):1015–1023

    Article  PubMed  Google Scholar 

  26. Irlenbusch U, End S, Kilic M (2010) Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis. Int Orthop 35(5):705–711

    Article  PubMed  Google Scholar 

  27. Irlenbusch U, Forke L, Fuhrmann U et al (2010) Establishing the differential indication for anatomical and reversed shoulder endoprostheses in rheumatoid arthritis. Z Rheumatol 69(3):240–249

    Article  PubMed  CAS  Google Scholar 

  28. Irlenbusch U, Rott O, Gebhardt K, Werner A (2008) Reconstruction of the rotational centre of the humeral head depending on the prosthetic design. Z Orthop Unfall 146(2):211–217

    Article  PubMed  CAS  Google Scholar 

  29. Kadum B, Mafi N, Norberg S, Sayed-Noor AS (2011) Results of the Total Evolutive Shoulder System (TESS®): a single-centre study of 56 consecutive patients. Arch Orthop Trauma Surg

  30. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–501

    Article  PubMed  CAS  Google Scholar 

  31. Kontakis G, Tosounidis T, Galanakis I, Megas P (2008) Prosthetic replacement for proximal humeral fractures. Injury 39(12):1345–1358

    Article  PubMed  Google Scholar 

  32. Larsen A (1975) A radiological method for grading the severity of rheumatoid arthritis. Scand J Rheumatol 4(4):225–233

    Article  PubMed  CAS  Google Scholar 

  33. Lo IK, Litchfield RB, Griffin S et al (2005) Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial. J Bone Joint Surg Am 87(10):2178–2185

    Article  PubMed  Google Scholar 

  34. Loew M, Raiß P, Rickert M (2007) Die „Cuff Tear Arthropathy“ der Schulter – Versuch einer symptombasierten Einteilung. Obere Extremität 2:19–24

    Article  Google Scholar 

  35. Loew M, Raiss P, Kasten P, Rickert M (2007) Shoulder arthroplasty following rotator cuff tear: acquired arthropathy of the shoulder. Orthopäde 36(11):988–995

    Article  PubMed  CAS  Google Scholar 

  36. Miller BS, Joseph TA, Noonan TJ et al (2005) Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elbow Surg 14(5):492–496

    Article  PubMed  Google Scholar 

  37. Pape G, Zeifang F, Bruckner T et al (2010) Humeral surface replacement for the sequelae of fractures of the proximal humerus. J Bone Joint Surg Br 92(10):1403–1409

    Article  PubMed  CAS  Google Scholar 

  38. Rahme H, Mattsson P, Wikblad L, Larsson S (2006) Cement and press-fit humeral stem fixation provides similar results in rheumatoid patients. Clin Orthop Relat Res 448:28–32

    Article  PubMed  Google Scholar 

  39. Schoch C, Huth J, Aghajev E et al (2011) Die metaphysär verankerte Prothese bei postraumatischer und primärer Omarthrose. Kurzfristige Ergebnisse. Obere Extremität 6(4):275–281

    Article  Google Scholar 

  40. Tammachote N, Sperling JW, Vathana T et al (2009) Long-term results of cemented metal-backed glenoid components for osteoarthritis of the shoulder. J Bone Joint Surg Am 91(1):160–166

    Article  PubMed  Google Scholar 

  41. Walch G, Boileau P, Noel E (2010) Shoulder arthroplasty: evolving techniques and indications. Joint Bone Spine 77(6):501–505

    Article  PubMed  Google Scholar 

Download references

Danksagung

Diese Arbeit wurde unterstützt durch die Deutsche Arthrose Hilfe e. V.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    A. Berth & C. Lohmann

  2. Orthopädisch-Traumatologisches Zentrum, Parkkrankenhaus Leipzig – Südost, Leipzig, Deutschland

    G. Pap

Authors
  1. A. Berth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Pap
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Lohmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Berth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Berth, A., Pap, G. & Lohmann, C. Indikationsspezifische mittelfristige Ergebnisse der anatomischen Kurzschaft-Schulterprothese. Obere Extremität 7, 83–90 (2012). https://doi.org/10.1007/s11678-012-0162-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-012-0162-4

Schlüsselwörter

Keywords

Search

Navigation