Inverse Schulterendoprothetik – aktueller Stand

Die inverse Schulterendoprothetik hat im Laufe der letzten Dekade einen immensen Zuwachs in der Behandlung verschiedener Schulterpathologien erfahren. Begründet wird dieser durch verlässliche Kurz- und vielversprechende Langzeitergebnisse sowie weiterentwickelte Endoprothesendesigns. Dieser Artikel gibt einen Überblick über die biomechanischen Eigenschaften, die aktuellen Indikationsfelder und klinischen Ergebnisse der inversen Schulterendoprothetik.

Abstract

Due to first promising long term outcome data, reverse shoulder arthroplasty experienced an immense increase of usage during the past decade. Moreover, the initial Grammont concept has constantly been refined and adapted to current scientific findings. Therefore, clinical and radiological problems like scapular notching and postoperative instability were constantly addressed but do still remain an area of concern.

This article summarises current concepts in reverse shoulder arthroplasty and gives an overview of actual indications like cuff tear arthropathy, severe osteoarthritis, proximal humerus fractures, tumours, fracture sequelae as well as revision surgery and their corresponding clinical and radiological results.

Kernaussagen

• Aufgrund vielversprechender Langzeitergebnisse der inversen Schulterendoprothetik zeigte sich innerhalb der letzten Jahre eine Ausweitung des Indikationsspektrums.

• Durch die Verringerung des humeralen Inklinationswinkels von 155° auf 145° oder 135° konnte das skapuläre Notching, im Vergleich zum initialen Grammont-Design, maßgeblich reduziert werden.

• Es zeigt sich ein Trend zur vermehrten humeralen sowie glenoidalen Lateralisierung im Vergleich zum initialen Grammont-Design.

• Trotz des erheblichen Fortschritts innerhalb des letzten Jahrzehnts verbleiben postoperative Infektionen und die Instabilität sowie mögliche Lockerungen und implantatassoziierte Frakturen als ernst zu nehmende Komplikationen.

• Als vielversprechende, zukunftsträchtige Themen gelten die skapulothorakale Orientierung, die Modifizierung und Weiterentwicklung der inversen Endoprothesenmodelle hin zu Kurzschaft-/schaftlosen Endoprothesenmodellen sowie zur Implementierung der virtuellen Realität in den Behandlungsalltag der inversen Schulterendoprothetik.

Schlüsselwörter

inverse Schulterendoprothese - Schulter - Arthrose - Defektarthropathie

Keywords

reverse shoulder arthroplasty - shoulder - arthritis - cuff tear arthropathy

Publication History

Article published online:
22 March 2024

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