Komplikationen nach inversen Schulterprothesen – Ursache, Prävention und Behandlungsstrategien

 

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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.

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