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Aktuelle Rheumatologie 2014; 39(02): 88-95
DOI: 10.1055/s-0034-1367016
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Design folgt Funktion – Differenzialindikation anatomischer, inverser und bipolarer Schulterendoprothesen bei der chronischen Polyarthritis

Design Follows Function – Differential Indication for Anatomic, Reversed and Bipolar Shoulder Endoprostheses in Rheumatoid Arthritis
U. Irlenbusch
1   Marienstift Arnstadt, Orthopädische Klinik, Arnstadt
,
U. Lorenz
1   Marienstift Arnstadt, Orthopädische Klinik, Arnstadt
,
L. Forke
1   Marienstift Arnstadt, Orthopädische Klinik, Arnstadt
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
19. März 2014 (online)

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Zusammenfassung

Die Implantation einer anatomischen Schulterendoprothese (Oberflächen-, Kurzschaft- oder Schaftprothese) bei c.P. kann nur zu einer guten Funktion führen, wenn die Rotatorenmanschette intakt oder reparabel ist. Anderenfalls ist nur ein begrenztes Ergebnis zu erwarten. Einen Ausweg aus dieser Situation stellt die Implantation einer halbgekoppelten inversen Endoprothese dar. Diese Prothese besitzt einen fixen Drehpunkt, sodass die Rotatorenmanschette zur Stabilisierung nicht erforderlich ist. Die funktionellen Ergebnisse entsprechen trotz der ungünstigeren Ausgangssituation in etwa denen anatomischer Prothesen. Obwohl inverse Prothesen auch in schwersten Fällen eine deutliche Funktionsverbesserung und Schmerzlinderung erlauben, ist ihre Einsatzmöglichkeit begrenzt. Die Destruktion des Glenoids sowie die oft ausgeprägte Osteoporose erlauben gelegentlich keine sichere­ Verankerung der Glenoidkomponente. Die ­Prothese sollte deshalb nur bei strenger Indikationsstellung implantiert werden. Ob aktuelle Verbesserungen der Implantate und der Operationstechnik tatsächlich eine Verlängerung der Standzeit bewirken, muss noch abgewartet werden. Ein geeignetes Reserveimplantat ist deshalb in den Bipolarprothesen zu sehen, da sich diese insbesondere für hochgradige Pfannendefekte bei gleichzeitig bestehendem Rotatorendefekt sowie für sekundäre Arthrosen mit hochgradiger Osteoporose des Humeruskopfes eignen.

Abstract

Implantation of an anatomic shoulder prosthesis (surface, short-shaft or shaft prosthesis) in patients with rheumatoid arthritis may lead to a good outcome, provided the rotator cuff is intact or can be repaired. If these prerequisites are not met, only limited results can be expected. Under these circumstances, one viable solution is the implantation of a semi-coupled reverse prosthesis. With a fixed centre of rotation, this prosthesis does not require an intact rotator cuff for stabilisation. Despite the unfavourable pre-operative situation, the functional outcomes are very similar to those achieved with anatomic prostheses. While implantation of a reversed shoulder prosthesis can lead to significant functional improvements and pain reduction even in most severe cases, its potential use is limited. Glenoid destruction and frequently associated significant osteoporosis prevent at times the secure anchoring of the glenoid component. Therefore, stringent criteria should be applied when establishing the indication for implantation of this prosthesis. It remains to be seen, whether implant design improvements and more advanced surgical techniques will ultimately lead to a prolonged lifetime of this prosthesis. Consequently, bipolar prostheses should be regarded as suitable alternative implants, as they are especially suited for severe glenoid defects accompanied by pre-existing rotator cuff defects and for cases of secondary osteoarthritis accompanied by severe osteoporosis of the humeral head.

Schlüsselwörter

anatomische Schulter­prothese - inverse Schulterprothese - Rheumatoidarthritis - chronische Polyarthritis - Osteoarthritis

Key words

anatomic shoulder ­prosthesis - reversed shoulder prosthesis - inversed prosthesis - rheumatoid arthritis - chronic polyarthritis - glenohumeral osteoarthritis
 

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