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Standzeiten und Komplikationen der Schaftendoprothesen bei Omarthrose

Survival rate and complications of stemmed shoulder prostheses in primary osteoarthritis

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Zusammenfassung

Die Standzeit und Überlebensrate von Schulterprothesen werden von zahlreichen Komplikationsmöglichkeiten beeinflusst. Die Auswertung der aktuellen Literatur und Prothesenregister zeigt aber insgesamt eine geringe Revisions- (1,39 Revisionen/100 Beobachtungsjahre) und Lockerungsrate (implantatbezogene 10-Jahres-Überlebensrate bis zu 99 %), die mit derjenigen aus der Hüft- und Knieendoprothetik vergleichbar ist. Hervorzuheben ist, dass zementfreie Schäfte häufiger Probleme bereiten als zementierte Komponenten (4,34 vs. 0,77 Revisionen/100 Beobachtungsjahre) sowie dass sekundäre Rotatorenmanschettenrupturen (4,6 %; Funktionsdefizit bis zu 30 %) häufiger sind als allgemein angenommen und oftmals nur inkonsequent diagnostiziert und behandelt werden. Die Infektionsrate liegt bei ca. 1 %, die Luxationsrate ist in der neueren Literatur rückläufig und wird mit ca. 5 % angegeben.

Die niedrige Komplikations- und Revisionsrate rechtfertigt die Verdrängung der Schaftprothesen durch schaftfreie Implantate und Kurzschaftprothesen nicht, sondern die Bevorzugung der neuen Implantate ist auf die besseren Revisionsmöglichkeiten und die leichtere Konvertierbarkeit in eine inverse Prothese zurückzuführen.

Abstract

Survivorship and survival rate of shoulder prostheses can be affected by a large number of possible complications. An evaluation of the current literature and the prosthesis register, however, shows an overall low revision (1.39 revisions per 100 observation years) and loosening rates (implant-related 10-year survival rate up to 99 %), comparable to that of hip and knee endoprostheses. It must be emphasized that cementless stems more often cause problems than cemented components (4.34 compared to 0.77 revisions per 100 observation years) and that secondary rotator cuff rupture (4.6 %; functional deficit up to 30 %) occurs more frequently than was generally assumed and is often not diagnosed or treated adequately. The infection rate amounts to approximately 1 % and according to latest literature the dislocation rate is regressive and is estimated to be approximately 5 %.

The low complication and revision rates do not justify the replacement of stemmed prostheses by stemless implants and short stem prostheses and the preference given to the new implants is attributed more to the better revision possibilities and easier convertibility into inverse prostheses.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Er unterhält einen Beratervertrag mit der Firma Mathys Ltd., Bettlach, Schweiz.

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  1. Orthopädische Klinik, Marienstift Arnstadt , Wachsenburgallee 12, 99310, Arnstadt, Deutschland

    U. Irlenbusch

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Irlenbusch, U. Standzeiten und Komplikationen der Schaftendoprothesen bei Omarthrose. Orthopäde 42, 507–515 (2013). https://doi.org/10.1007/s00132-012-2022-8

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