Zusammenfassung
Die primäre Omarthrose ist eine degenerative Erkrankung des glenohumeralen Gelenks, die im zeitlichen Verlauf zu Schmerzen, Bewegungseinschränkungen, Verlust an Lebensqualität und knöchernen Abrieb führen kann. Typischerweise kommt die Omarthrose im höheren Lebensalter vor und hat eine enorme sozioökonomische Bedeutung. Klinisch imponiert sie mit einer schmerzhaften Einschränkung der Beweglichkeit, insbesondere in der Außenrotation. Radiologisch sind im fortgeschrittenen Stadium die klassischen Zeichen einer Arthrose evident (Sklerosierung, Osteophyten, Gelenkspaltverschmälerung oder Aufhebung und Zystenbildung). In der CT sind in vielen Fällen konzentrische oder exzentrische Abriebe im Bereich des Glenoids mit oder ohne einer Subluxationsstellung des Humeruskopfes zu finden. Die Glenoidmorphologie wird klassischerweise nach Walch eingeteilt, alternative Messmethoden sind die sog. Fulcurm-Achse oder die sog. Friedmann-Linie. Gerade im Frühstadium der Omarthrose ist die konservative Therapie mit Krankengymnastik, Antiphlogistika und Injektionen von Bedeutung. Hierdurch können häufig zumindest teilweise die Schmerzsituation verbessert und die Beweglichkeit und Kraft erhalten bleiben. Minimalinvasive Operationsmethoden haben mit der sog. CAM-Prozedur bei ausgewählten Indikationen einen Stellenwert. Bei dem arthroskopischen Verfahren werden unter anderem der Knorpel geglättet, die lange Bizepssehne tenotomiert oder tenodesiert, sowie ein Kapselrelease und Osteophytenresektionen durchgeführt. Laut Studienlage führt diese Prozedur nur bei einem Teil der Patienten zu einer Verbesserung der Symptomatik und bleibt somit Einzelfällen vorbehalten. Sollten diese Therapiemaßnahmen nicht zum gewünschten Erfolg führen, bleibt der endoprothetische Ersatz des Gelenkes als Ultima Ratio übrig. Die exakte präoperative Abklärung und Diagnostik sind für die Versorgung und das langfristige Ergebnis entscheidend. Neben Röntgenbildern in zwei Ebenen kann eine MRT zur Beurteilung der Rotatorenmanschette vorteilhaft sein. Eine präoperative CT hilft insbesondere in Kombination mit einer 3D-Planungs-Software bei der Entscheidungsfindung zur Implantatwahl und Positionierung. Knackpunkt in der anatomischen Endoprothetik bleibt die Versorgung des Glenoids und der Status der Rotatorenmanschette im zeitlichen Verlauf. Der totale Gelenkersatz ist der Hemiprothese in Bezug auf Schmerzreduktion, Funktion und Patientenzufriedenheit in nahezu allen Studien überlegen. In der Hemiendoprothetik ist der Abrieb des nativen Glenoids eine häufige Komplikation im Langzeitverlauf, die zu Schmerzen und einem schlechten klinischen Ergebnis führen kann. Im Gegensatz hierzu ist die Lockerung der Glenoidkomponente eines der Hauptprobleme bei der Totalendoprothetik, insbesondere ab dem 10. postoperativen Jahr. Bis dorthin sind in vielen Studien stabile klinische und radiologische Ergebnisse beschrieben worden. Dementsprechend gewinnt die inverse Prothese insbesondere bei bikonkaven Glenoidtypen und insuffizienter Rotatorenmanschette auch bei primären Omarthrosen an Bedeutung, da hier die Lockerungsraten der Glenoidkomponente vergleichsweise niedrig sind.
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Raiss, P., Müller, P., Zeifang, F. (2023). Primäre Omarthrose. In: Perka, C., Heller, KD. (eds) AE-Manual der Endoprothetik. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55485-2_6-1
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