Zusammenfassung
Hintergrund
Ziel dieser prospektiven Studie war die Analyse der Ergebnisse des zementfreien Oberflächenersatz des Oberarmkopfes an verschiedenen Pathologien des Schultergelenkes bei Patienten <55 Jahren.
Patienten und Methoden
Vor und im Mittel 2,5 (1–6) Jahre nach der Operation wurden 23 Patienten (26 Implantate) mit Oberflächenersatzprothesen des Oberarmkopfes untersucht. Zehn Patienten wurden aufgrund einer posttraumatischen Omarthrose und 7 Patienten aufgrund einer primären Omarthrose versorgt. Bei 6 Patienten lag eine Oberarmkopfnekrose vor. Neben dem Constant-Score wurde die Beweglichkeit und die Patientenzufriedenheit evaluiert.
Ergebnisse
Der mittlere Constant-Score des Gesamtkollektivs konnte signifikant von 33 (8–69) Punkten präoperativ auf 61 (25–83) Punkte postoperativ angehoben werden (p<0,0001). Der alters- und geschlechtsadaptierte Constant-Score verbesserte sich im Mittel von 38% (8–86%) auf 70% (28–114%; p<0,0001). Signifikante Verbesserungen prä- vs. postoperativ wurden für das Gesamtkollektiv für den Schmerz, die Aktivität, die Mobilität, Schulter Flexion, Abduktion und Außen-/Innenrotation gefunden (p<0,001). In einem Fall war ein Wechsel in eine Totalendoprothese aufgrund einer Glenoiderosion und in einem Fall eine weichteilige Reoperation aufgrund eines oberflächigen Wundinfekts notwendig.
Schlussfolgerung
Der zementfreie Oberflächenersatz des Oberarmkopfes stellt eine knochensparende endoprothetische Therapieoption im Vergleich zur Humeruskopfprothese für junge Patienten dar. Gute klinische Ergebnisse, eine hohe Patientenzufriedenheit und eine relativ niedrige Komplikationsrate konnten gezeigt werden. Langzeituntersuchungen sind notwendig, um diese Ergebnisse zu bestätigen.
Abstract
Background
Cementless humeral surface replacement arthroplasty is a viable treatment option for degenerative diseases of the shoulder joint. The aim of this prospective study was to analyse the results of this treatment option in patients younger than 55 years of age with different pathologies of the shoulder.
Patients and methods
Twenty-three patients (26 implants) treated with cementless humeral surface replacement arthroplasty were included in this study. Mean follow-up was 2.5 years (1–6 years). Ten patients had posttraumatic osteoarthritis, seven had primary osteoarthritis, and six had osteonecrosis. Patients were evaluated using the Constant score, shoulder motion, and subjective satisfaction.
Results
The mean Constant score increased significantly from 33 points preoperatively (8–69 points) to 61 points postoperatively (25–83 points; p<0.0001), adjusted to age and gender from 38% (8–86%) to 70% (28–114%; p<0.0001). Significant improvement for the whole cohort was found regarding patients’ pain, activity, mobility, shoulder flexion and abduction, and internal and external rotation (p<0.001). In one case, reoperation was necessary due to a superficial wound infection, and in another case, implant revision to a total shoulder replacement was performed because of glenoid erosion.
Conclusion
Cementless humeral surface replacement arthroplasty is a viable bone-preserving treatment option for young and active patients. Later conversion to total shoulder replacement is possible. Good clinical results, a low complication rate, and high patient satisfaction were found in the short and mid term. Long-term investigations are necessary to confirm these observations.
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Danksagung
Wir danken der „Deutschen Arthrose-Hilfe e.V.“ für die Unterstützung bei der Durchführung dieser Studie.
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Raiss, P., Pape, G., Becker, S. et al. Der zementfreie Oberflächenersatz des Humeruskopfes bei Patienten unter 55 Jahren. Orthopäde 39, 201–208 (2010). https://doi.org/10.1007/s00132-009-1525-4
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DOI: https://doi.org/10.1007/s00132-009-1525-4