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Arthritis und Rheuma 2011; 31(05): 309-313
DOI: 10.1055/s-0037-1618081
Endoprothetik und Rheuma
Schattauer GmbH

Oberflächenersatz oder inverse Prothese an der rheumatischen Schulter

Surface replacement or inverse prosthesis in rheumatoid shoulders
B. Fink
1   Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen
,
W. Rüther
2   Klinik für Orthopädie des Klinikums Bad Bramstedt
› Author Affiliations
Further Information

Publication History

Publication Date:
26 December 2017 (online)

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Zusammenfassung

Bei höhergradigen Destruktionen des Glenohumeralgelenks bei rheumatoider Arthritis bedarf es eines endoprothetischen Ersatzes dieses Gelenks. Da bei etwa der Hälfte der Patienten zum Zeitpunkt der Operation eine defizitäre Rotatorenmanschette vorliegt und in einem hohen Prozentsatz sekundäre Insuffizienzen nach endoprothetischem Ersatz auftreten, wird von vielen Operateuren, trotz in der Regel besseren klinischen Ergebnissen der Totalendoprothese, eine Hemiarthroplastik bevorzugt. Eine Möglichkeit hierbei stellt der Oberflächenersatz des Humeruskopfes dar. Die Vorteile der Cuparthroplastik liegen hierbei in der geringen Invasivität und einfachen Technik mit knochensparender Fixierung sowie der guten Rückzugmöglichkeiten. Daher empfehlt sich die Cuparthroplastik in erster Linie bei jüngeren Patienten mit rheumatoider Arthritis. Bei Rotatorenmanschettenmassenruptur kann sie in einer valgischen Position implantiert werden und so mit dem Akromion artikulieren. Aufgrund der guten Rückzugsmöglichkeiten werden die schlechteren klinischen Ergebnisse im Ver gleich zur inversen Prothese in Kauf genommen, da man inverse Prothesen aufgrund mangelnder Rückzugsmöglichkeiten bei Patienten ab dem 70. Lebensjahr bei Rotatorenmanschettenmassenruptur implantiert. Aufgrund der Distalisierung und Medialisierung des Drehzentrums durch die inverse Prothese werden deutlich bessere klinische Ergebnisse erreicht als durch den Oberflächen ersatz oder andere Hemi- und Totalendoprothesen bei Rotatorenmanschettenmassenrupturen.

Summary

The therapeutic method of choice in cases of severe rheumatic destruction of the glenohumeral joint is allo-arthroplasty. Up to 50 % of rheumatic shoulders present significant defects in the rotator cuff at the time of joint replacement and a high percentage develop secondary cuff defects after the implantation. Therefore hemiarthroplasty has advantages over total joint replacement even though clinical results are inferior to total joint replacement. One possibility for hemiarthroplasty is the surface replacement of the humeral head. The advantages of this concept are bone preserving fixation and the good opportunity for salvage procedures in the case of failure. In cases of massive cuff tear the surface replacement can be implanted in a valgus position to articulate with the glenoid and the acromion. Therefore surface replacement has its indication in patients under the age of 70. In these patients inverse protheses are not recommended because of the lack of salvage procedures. In patients over 70 years and massive rotator cuff tears inverse prostheses have their indication. Because of distalisation and medialisation of the center of rotation the functional results are much better than with surface replacement or other hemi- or total arthroplasties.

Schlüsselwörter

Oberflächenersatz - inverse Prothese - Rotatorenmanschettenmassenruptur - rheumatoide Arthritis

Keywords

Surface replacement - inverse prosthesis - massive cuff tear - rheumatoid arthritis
 

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