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Z Orthop Unfall 2018; 156(02): 227-238
DOI: 10.1055/s-0043-118043
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Schulterendoprothetik

Shoulder Arthroplasty
Anna Krukenberg
,
Jan-Philipp Imiolczyk
,
Philipp Moroder
,
Markus Scheibel
Further Information

Publication History

Publication Date:
17 April 2018 (online)

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Zusammmenfassung

Die Schulterendoprothetik hat in den letzten Jahren zunehmend an Aufmerksamkeit gewonnen. So können mittlerweile nicht nur bessere klinische und radiologische Ergebnisse erzielt werden, sondern auch das Indikationsspektrum konnte erweitert werden. Der folgende Artikel gibt einen Überblick über die Historie, die Indikationen, die aktuellen Konzepte und Ergebnisse und Komplikationen der Schulterendoprothetik.

Abstract

Shoulder arthroplasty has been performed increasingly during the last years. The concept of modern anatomic shoulder arthroplasty is based on C. S. Neerʼs first shoulder prosthesis in the 1950s which was originally designed for the treatment of fractures of the proximal humerus. Since then, this monoblock prosthesis has undergone many changes and improvements. By now, an anatomic reconstruction of the joint is possible. Hence, the indications for anatomic shoulder arthroplasty have been added amongst others by osteoarthritis, necrosis, rheumatoid arthritis or posttraumatic arthritis. For years stemmed shoulder arthroplasty has been state of the art with a good clinical and radiological outcome. Nevertheless, stem-related problems occurred leading to the invention of short-stem and stem-free shoulder prosthesis. Stem-free shoulder arthroplasty allows an even better anatomic reconstruction and therefore offers more opportunities, e.g. in a severe posttraumatic status. Only short- to midterm results are published so far but those are very convincing indicating that stem-free shoulder arthroplasty is the future. Reverse shoulder arthroplasty has its origin in the 1980s. Paul Grammont invented a reversed shoulder prosthesis for patients suffering from cuff arthropathy. The center of rotation is medialised and inferiorised using the pre-loading of the deltoid muscle to move the shoulder joint. The initial prosthesis had undergone many variations as well but in contrast to anatomic shoulder arthroplasty biomechanics is still discussed a lot in reverse shoulder arthroplasty; especially in terms of finding the right inclination angle or how to prevent instability or scapular notching. This article gives a review about indications, concepts and complications of shoulder arthroplasty.

Kernaussagen

  • Die Implantation von Schulterendoprothesen nimmt progredient zu.

  • State of the Art sind aufgrund langer Nachuntersuchungszeiträume Schaftendoprothesen.

  • Der Trend geht hin zur Verwendung schaftfreier Implantate.

  • Langzeitstudien schaftfreier Implantate stehen noch aus, kurz- und mittelfristige Studien zeigen allerdings bereits gute und vergleichbare klinische und radiologische Ergebnisse.

  • Das Indikationsspektrum der inversen Schulterendoprothese hat sich in den letzten Jahren stetig erweitert.

  • Die Hauptprobleme der inversen Schulterendoprothetik sind

    • Instabilität,

    • Infektion und

    • Lockerung.

Schlüsselwörter

anatomische Schulterendoprothetik - inverse Schulterendoprothetik - Schulterendoprothesen - Schaftprothese - schaftfreie Prothese - Omarthrose

Key words

anatomic shoulder arthroplasty - reverse shoulder arthroplasty - shoulder arthroplasty - stem - stem-free prosthesis - omarthrosis
 

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