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Defektarthropathie – Langzeitergebnisse der inversen Schultertotalendoprothesenimplantation

Cuff tear arthropathy – long-term results of reverse total shoulder arthroplasty

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Zusammenfassung

Bei Defektarthropathie sind die Ergebnisse nach inverser Prothesenimplantation besser und die Komplikationen geringer als bei anderen Indikationen wie z. B. Rheuma, Fraktur, -folgen oder sogar Revisionen. Sehr gute funktionelle Ergebnisse zeigen sich für die Elevation und den Schmerz, die Rotation bleibt unverändert. Revisionen und Komplikationen treten in den ersten 3 Jahren auf, dann ist die Überlebensquote mit etwa 90 % auch nach 10 Jahren gut. Progressive funktionelle und radiologische Verschlechterungen, ohne ersichtliche mechanische Komplikationen, finden sich aber nach 9 Jahren bei ca. einem Drittel der Patienten. „Notching“ ist ein mit der Zeit progredientes Phänomen, das bislang nicht sicher mit funktioneller Verschlechterung einhergeht. Modifikationen der Implantate, der Implantationstechnik und Erfahrung konnten die Ergebnisse signifikant bessern und die Komplikationsraten senken. Die Lateralisation des Drehzentrums und Verminderung der Inklination helfen, die Notchingrate zu senken und die Beweglichkeit, v. a. die Rotation, zu steigern. Neue Prothesenmodelle und Operationstechniken versuchen die Kombination der verschiedenen biomechanischen Verbesserungen umzusetzen. Die inverse Prothese bleibt eine anspruchsvolle Operation mit hoher Komplikationsrate. Das Ergebnis hängt von der Indikation und der Funktion der verbliebenen Muskulatur ab und damit auch von der Erfahrung des Operateurs, die biomechanischen Faktoren optimal umzusetzen. Wegen der funktionellen Verschlechterung bleibt die Indikation älteren Patienten über 70 Jahren vorbehalten.

Abstract

The results after reverse total shoulder arthroplasty for cuff tear arthropathy are superior and the complications fewer than for other etiologies, such as rheumatoid arthritis, fracture, fracture sequelae or even revision. The improvements in function and pain are excellent whereas rotation may be unaffected. Revisions and complications can be encountered in the first 3 years and the survival curve of the prosthesis is still good after 10 years with 90 %. Progressive functional and radiological deterioration is observed after 9 years in approximately 30 % of the patients without apparent problems with the prosthesis. Notching is progressive with incidence and size over time, without a proven correlation to the functional results but remains a major concern. Modification of the implants, the operative techniques and experience could significantly improve the results and reduce the rate of complications. Lateralization of the center of rotation and smaller inclination angles have a positive effect on the rate of notching and the range of motion, especially for the rotation. New prosthetic designs and operative techniques attempt to implement a combination of the biomechanical improvements. Reverse shoulder arthroplasty remains a challenging operation with a high rate of complications. The results depend on the etiology and the function of the remaining muscles and therefore on the experience and the skill of the surgeon to implement the appropriate biomechanical factors. Because of the concerns regarding the longevity, reverse shoulder arthroplasty should be reserved for the elderly over 70 years of age.

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  1. Klinik für Unfall-, Schulter- und Handchirurgie, Krankenhaus Agatharied, Norbert Kerkel Platz 1, 83734, Hausham, Deutschland

    U. Brunner, K. Rückl & M. Fruth

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  1. U. Brunner
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  2. K. Rückl
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  3. M. Fruth
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Correspondence to U. Brunner.

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Brunner, U., Rückl, K. & Fruth, M. Defektarthropathie – Langzeitergebnisse der inversen Schultertotalendoprothesenimplantation. Orthopäde 42, 522–530 (2013). https://doi.org/10.1007/s00132-012-2023-7

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  • DOI: https://doi.org/10.1007/s00132-012-2023-7

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