Komplikationen nach inversen Schulterprothesen – Ursache, Prävention und Behandlungsstrategien

Zusammenfassung

Nach der Einführung der inversen Schulterprothese in den 1970er-Jahren waren die klinischen Ergebnisse enttäuschend. Dies war bedingt durch das voll-rigide Design und das lateral ausgerichtete Drehzentrum. Dies führte zu großen Scherkräften und Versagen der glenoidalen Komponente. In den 1980er-Jahren wurde das Drehzentrum weiter medialisiert und kaudalisiert, eine größere Glenosphäre verwendet, die mit einer Humeruspfanne mit einem Hals/Schaftwinkel von 155° artikuliert. Die klinischen Ergebnisse verbesserten sich deutlich, und die inverse Schulterprothese entwickelte sich zu einer etablierten Behandlungsmethode. Anfänglich konzipiert zur Behandlung von symptomatischen Glenohumeralarthrosen und schweren Rotatorenmanschettenschäden, hat sich das Indikationsspektrum über die Jahre stark erweitert. Trotz der heutzutage großen Popularität der inversen Prothese stellt eine immer noch deutlich höhere Komplikationsrate im Vergleich zu anatomischen Schulterprothesen ein Problem dar. Typische Komplikationen sind Scapular Notching, Versagen der Basisplatte, periprothetische Frakturen, Skapulafrakturen, Infektionen, Hämatome, Instabilität und Nervenläsionen. Nur wenige Publikationen beschäftigen sich mit Präventionsmaßnahmen und zeigen Behandlungsstrategien auf.

Abstract

After introduction of the reverse shoulder prosthesis in the 1970 s, clinical outcome was poor. This was mostly caused by the constraint design and the lateralised centre of rotation, which caused shear forces and glenoid failure. In the 1980 s the centre of rotation was medialised and caudalised, a larger glenosphere and a neck/shaft angle of 155° were used. The clinical outcome data became better and the reverse shoulder prosthesis established as a treatment option. Initially used for symptomatic glenohumeral arthritis in combination with severe rotator cuff pathologies, the indications have been expanded. In spite of its great popularity, the reverse shoulder prosthesis is associated with higher complication rates than anatomic shoulder arthroplasties. Typical complications include scapular notching, baseplate failure, periprosthetic fractures, scapular fractures, infections, haematoma, instability and nerve leasions. Only few publications provide prevention or treatment strategies.

Schlüsselwörter

inverse Schulterprothese - Komplikationen - Ursache - Prävention - Behandlungsstrategien

Key words

reverse shoulder arthroplasty - complications - cause - prevention - treatment options

• Literatur

• 1 Bayley J, Kessel L. The Kessel total Shoulder Replacement. In: Bayley I, Kessel L, eds. Shoulder Surgery. New York: Springer-Verlag; 1982: 160-164
• 2 Nyffeler RW, Werner CML, Simmen BR et al. Analysis of a retrieved delta III total shoulder prosthesis. J Bone Joint Surg Br 2004; 86: 1187-1191
• 3 Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993; 16: 65-68
• 4 Sirveaux F, Favard L, Oudet D et al. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004; 86: 388-395
• 5 Boileau P, Watkinson D, Hatzidakis AM et al. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 2006; 15: 527-540
• 6 Wall B, Nové-Josserand L, OʼConnor DP et al. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007; 89: 1476-1485
• 7 Frankle M, Siegal S, Pupello D et al. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am 2005; 87: 1697-1705
• 8 Werner CML, Steinmann PA, Gilbart M et al. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005; 87: 1476-1486
• 9 Guery J, Favard L, Sirveaux F et al. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006; 88: 1742-1747
• 10 Levy J, Frankle M, Mighell M et al. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am 2007; 89: 292-300
• 11 Levy JC, Virani N, Pupello D et al. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br 2007; 89: 189-195
• 12 Cuff D, Pupello D, Virani N et al. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 2008; 90: 1244-1251
• 13 Boileau P, Gonzalez J-F, Chuinard C et al. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg 2009; 18: 600-606
• 14 Mulieri P, Dunning P, Klein S et al. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am 2010; 92: 2544-2556
• 15 Kempton LB, Ankerson E, Wiater JM. A complication-based learning curve from 200 reverse shoulder arthroplasties. Clin Orthop Relat Res 2011; 469: 2496-2504
• 16 Flury MP, Frey P, Goldhahn J et al. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure–midterm results. Int Orthop 2011; 35: 53-60
• 17 Lévigne C, Boileau P, Favard L et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2008; 17: 925-935
• 18 Simovitch RW, Zumstein MA, Lohri E et al. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am 2007; 89: 588-600
• 19 Nyffeler RW, Werner CML, Gerber C. Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis. J Shoulder Elbow Surg 2005; 14: 524-528
• 20 Gutiérrez S, Levy JC, Frankle MA et al. Evaluation of abduction range of motion and avoidance of inferior scapular impingement in a reverse shoulder model. J Shoulder Elbow Surg 2008; 17: 608-615
• 21 Kempton LB, Balasubramaniam M, Ankerson E et al. A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2011; 20: 571-576
• 22 Gutiérrez S, Keller TS, Levy JC et al. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res 2008; 466: 670-676
• 23 Gutiérrez S, Walker M, Willis M et al. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty. J Shoulder Elbow Surg 2011; 20: 732-739
• 24 Boileau P, Moineau G, Roussanne Y et al. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res 2011; 469: 2558-2567
• 25 Harman M, Frankle M, Vasey M et al. Initial glenoid component fixation in “reverse” total shoulder arthroplasty: a biomechanical evaluation. J Shoulder Elbow Surg 2005; 14: 162S-167S
• 26 Hopkins AR, Hansen UN, Bull AMJ et al. Fixation of the reversed shoulder prosthesis. J Shoulder Elbow Surg 2008; 17: 974-980
• 27 Jasty M, Bragdon C, Burke D et al. In vivo skeletal responses to porous-surfaced implants subjected to small induced motions. J Bone Joint Surg Am 1997; 79: 707-714
• 28 Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res 1986; 208: 108-113
• 29 Kwon YW, Forman RE, Walker PS et al. Analysis of reverse total shoulder joint forces and glenoid fixation. Bull NYU Hosp Jt Dis 2010; 68: 273-280
• 30 Frankle MA, Teramoto A, Luo Z-P et al. Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg 2009; 18: 874-885
• 31 Antuna SA, Sperling JW, Cofield RH et al. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 2001; 10: 217-224
• 32 Neyton L, Boileau P, Nové-Josserand L et al. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg 2007; 16: S71-S78
• 33 Boileau P, Watkinson DJ, Hatzidakis AM et al. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 2005; 14: S147-S161
• 34 Cheung E, Willis M, Walker M et al. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 2011; 19: 439-449
• 35 Sarmiento A, Kinman PB, Galvin EG et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am 1977; 59: 596-601
• 36 Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res 2011; 469: 2544-2549
• 37 Lädermann A, Williams MD, Melis B et al. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2009; 18: 588-595
• 38 Zumstein MA, Pinedo M, Old J et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2011; 20: 146-157
• 39 De Wilde L, Sys G, Julien Y et al. The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection. Acta Orthop Belg 2003; 69: 495-500
• 40 Capen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am 1996; 27: 83-86
• 41 National Institutes of Health. Obesity, physical activity, and weight control glossary. NIH publication No. 02-4976, U.S. Department of Health and Human Services. Im Internet: http://win.niddk.nih.gov/publications/glossary/MthruZ.htm%23O Stand: 26.7.2012
• 42 Dodson CC, Craig EV, Cordasco FA et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 2010; 19: 303-307
• 43 Zavala JA, Clark JC, Kissenberth MJ et al. Management of deep infection after reverse total shoulder arthroplasty: a case series. J Shoulder Elbow Surg 2012; 21: 1310-1315
• 44 Beekman PDA, Katusic D, Berghs BM et al. One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg Br 2010; 92: 817-822
• 45 Sabesan VJ, Ho JC, Kovacevic D et al. Two-stage reimplantation for treating prosthetic shoulder infections. Clin Orthop Relat Res 2011; 469: 2538-2543
• 46 Muh SJ, Streit JJ, Lenarz CJ et al. Resection arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg 2012; [Epub ahead of print]
• 47 Nowinski RJ, Gillespie RJ, Shishani Y et al. Antibiotic-loaded bone cement reduces deep infection rates for primary reverse total shoulder arthroplasty: a retrospective, cohort study of 501 shoulders. J Shoulder Elbow Surg 2012; 21: 324-328
• 48 Cheung EV, Sperling JW, Cofield RH. Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res 2008; 466: 1363-1367
• 49 Wierks C, Skolasky RL, Ji JH et al. Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res 2009; 467: 225-234
• 50 Habermeyer P, Lichtenberg S, Magosch P. Schulterchirurgie. 4.. Aufl. München: Urban & Fischer; 2010: 759
• 51 Lädermann A, Williams MD, Melis B et al. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2009; 18: 588-595
• 52 Klein SM, Dunning P, Mulieri P et al. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am 2010; 92: 1144-1154
• 53 Edwards TB, Williams MD, Labriola JE et al. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2009; 18: 892-896
• 54 Gutiérrez S, Comiskey 4th CA, Luo Z-P et al. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 2008; 90: 2606-2615
• 55 Zumstein MA, Pinedo M, Old J et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg; 2011; 20: 146-157
• 56 Lädermann A, Lübbeke A, Mélis B et al. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 2011; 93: 1288-1293
• 57 Bohsali KI, Wirth MA, Rockwood jr. CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am 2006; 88: 2279-2292
• 58 Wirth MA, Rockwood jr. CA. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am 1996; 78: 603-616
• 59 Van Hoof T, Gomes GT, Audenaert E et al. 3D computerized model for measuring strain and displacement of the brachial plexus following placement of reverse shoulder prosthesis. Anat Rec (Hoboken) 2008; 291: 1173-1185
• 60 Clark WL, Trumble TE, Swiontkowski MF et al. Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg Am 1992; 17: 677-687