Zusammenfassung
Hintergrund
Die Cuffarthropathie mit dem klinischen Bild der pseudoparalytischen Schulter stellt die klassische Indikation für die Implantation einer inversen Schulter (TEP) beim älteren Patienten dar. Bei korrekter Indikationsstellung, Operationstechnik und Implantatwahl können sehr gute klinische Ergebnisse mit Schmerzbefreiung und guter Funktion bei niedriger Komplikationsrate erreicht werden.
Fragestellung
Anhand dieser Übersichtsarbeit sollen Indikationen, klinische Ergebnisse, Komplikationen und deren Therapie sowie die Operationstechnik der inversen Schulterendoprothetik im Zusammenhang mit der irreparablen Rotatorenmanschettenruptur nähergebracht werden.
Material und Methoden
Selektive Literaturrecherche und die Vermittlung eigener klinischer Erfahrungen der Autoren.
Ergebnisse
Die Behandlung einer Rotatorenmanschettenmassenruptur mit einer inversen Schultertotalendoprothese sorgt für eine Funktionsverbesserung und eine Schmerzabnahme. Die Langzeitergebnisse einer inversen Schulterendoprothetik zeigen gute Überlebensraten, jedoch auch Funktionseinbußen.
Schlussfolgerungen
Trotz der sehr guten Ergebnisse der inversen Prothetik, insbesondere bei Patienten mit irreparablen Rotatorenmanschettendefekten, gilt es bei der Indikation zur inversen TEP eine Abgrenzung zur konservativen Therapie und zu gelenkerhaltenden Eingriffen vorzunehmen, um der Gefahr einer „Überindikation“ dieser Technik vorzubeugen.
Abstract
Background
The classical indication for a reverse shoulder arthroplasty (RSA) is cuff tear arthropathy with pseudoparalysis of the shoulder joint in the elderly patient. If the indication is correct and the operation is performed using an adequate technique, the implantation of a reverse total shoulder usually yields excellent clinical results eliminating pain and significantly improving shoulder function in this patient group.
Objective
The goal of this article is to present clinical results, complications and their therapy as well as the surgical technique of reverse total shoulder arthroplasty in the context of the cuff tear arthropathy.
Materials and methods
Selective review of the literature and transfer of the authors’ clinical experience.
Results
The treatment of massive rotator cuff tears with reverse total shoulder arthroplasty provides an improvement of clinical function and reduces pain. The long-term results of reverse total shoulder arthroplasty demonstrate a good survival rate but also a decrease of clinical function.
Conclusion
Despite the excellent results of RSA especially in patients with irreparable cuff tears, it is very important to respect the limit of the indications for RSA. In order not to “overindicate” RSA, the potentials of conservative treatment and joint preserving techniques must be known.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. PD Dr. Agneskirchner hat einen Beratervertrag mit der Fa. Lima, San Daniele, Italien.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Holschen, M., Agneskirchner, J. Inverse Schulterprothese – Indikation, Operationstechnik und Ergebnisse. Arthroskopie 27, 38–48 (2014). https://doi.org/10.1007/s00142-013-0771-y
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DOI: https://doi.org/10.1007/s00142-013-0771-y
Schlüsselwörter
- Cuffarthropathie
- Rotatorenmanschettendefekt
- Inverse Schulterprothese
- Pseudoparalyse
- Behandlungsergebnisse