Cuff-Arthropathie – inverse Schultertotalendoprothese (iSTEP)

Zusammenfassung

Die inverse Schultertotalendoprothese (iSTEP) hat sich bei der Cuff-Arthropathie als Standard entwickelt. 10-Jahres-Überlebensraten von mehr als 90% sind erzielbar. Es verbleiben jedoch Probleme und Komplikationen, die es zu verbessern gilt. Ein gestiegenes Verständnis der Biomechanik mit entsprechenden Optimierungen führt zu Neuentwicklungen wie unterschiedlichen Schaftsystemen, glenoidalen Modifikationen sowie verschiedenen Offset-Typen.

Abstract

The inverse total shoulder prosthesis is a standard treatment for cuff arthropathy. The number of implanted inverse total shoulder prostheses in Germany is significantly higher than that of the anatomical total shoulder prosthesis. Kaplan-Meier analyses show a 10-year result of inverse total shoulder prostheses after cuff arthropathy of 90%. The extent of the scapular notching correlates with the functional clinical outcome. The humeral anchoring principles of inverse total shoulder prosthesis differ considerably (from purely epiphyseal to diaphyseal). Inverse total shoulder prostheses show significant differences in humeral and glenoid offset as well as in shaft-neck angles. The large number of systems available differ considerably concerning anatomical and biomechanical parameters – the surgeons must be trained accordingly. Still, most shoulder replacements are implanted by surgeons who rarely perform this procedure.

Kernaussagen

• Die inverse Schulter-TEP (iSTEP) ist eine Standardversorgung bei der Cuff-Arthropathie.

• Die Anzahl der implantierten iSTEP in Deutschland ist deutlich höher als die der anatomische Schultertotalendoprothese (aSTEP).

• Die meisten Schulterendoprothesen werden von Operateuren implantiert, die nur eine geringe Anzahl implantieren.

• Kaplan-Meier-Analysen zeigen ein 10-Jahres-Ergebnis von iSTEP nach Cuff-Arthropathie von 90%.

• Das Ausmaß des Skapula-Notching korreliert mit dem funktionellen klinischen Ergebnis.

• Die humeralen Verankerungsprinzipien von iSTEP differieren erheblich (von rein epiphysär bis diaphysär).

• iSTEP zeigen große Unterschiede bei humeralem und glenoidalem Offset.

• iSTEP zeigen Unterschiede bei Schaft-Hals-Winkeln.

• Die Vielzahl der auf dem Markt befindlichen Systeme unterscheidet sich erheblich in den anatomischen und biomechanischen Parametern – die Operateure müssen dementsprechend geschult sein.

Schlüsselwörter

Skapula - Cuff-Arthropathie - inverse Schulterendoprothese - iSTEP - Defektarthropathie - Biomechanik der Schulter - Rotatorenmanschettendefekt

Key words

inverse total shoulder prosthesis - shoulder arthropathy - biomechanics of the shoulder - scapula - cuff arthropathy

Publication History

Article published online:
27 September 2022

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