Revisionseingriffe in der Schulterendoprothetik

Zusammenfassung

Revisionseingriffe in der Schulterendoprothetik stellen höchste Ansprüche an das gesamte Team bez. Operationsplanung und Durchführung. Aufgrund der häufig komplexen Ausgangslage sind eine ausreichende Analyse der präoperativen Situation und die Auswahl geeigneter Wechselkomponenten essenziell. Dabei ist das gesamte Team einzubeziehen, da Rückzugsoptionen und ein schneller Verfahrenswechsel sichergestellt sein müssen. Die wesentlichen Wechselursachen sind mechanische Komplikationen durch Lockerung, Komponentenversagen oder Fraktur, Infektionen oder die Insuffizienz der Rotatorenmanschette nach der Implantation anatomischer Prothesen. Jedes dieser Versagensmuster verlangt eine spezifische Behandlung und Berücksichtigung unterschiedlicher Faktoren zur Erzielung einer funktionellen Verbesserung. Zur Durchführung muss ein spezielles Instrumentarium zur Verfügung stehen, mit dessen Anwendung das gesamte Team vertraut sein sollte. Infektionen sind durch den teilweisen oder kompletten Wechsel der Komponenten zu beherrschen. Hierbei kann eine antibiotikabeladene Interimsprothese je nach Ausmaß der Infektion notwendig werden.

Revision Operations on Total Shoulder Arthroplasties

The surgical planning and performance of revision operations on total shoulder arthroplasties place the highest demands on the entire team. On account of the often complex starting conditions, an adequate analysis of the preoperative situation and the choice of suitable revision components are mandatory. The entire team must be involved as options for reversal and/or a rapid change in the procedures must be available. The main reasons for a procedural change are mechanical complications due to loosening, component failures or fractures, infections or insufficiency of the rotator cuff after implantation of an anatomic prosthesis. Each of these reasons for failure requires a specific management and consideration of widely varying factors in order to achieve an improvement in function. Special instruments must be available and the entire team should be familiar with their use. Infections should be managed by partial or complete exchange of the components. In such cases an interim prosthesis charged with antibiotics may be necessary depending on the extent of the infection.

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