Skip to main content
SpringerLink
Log in

Glenohumerale Arthrolyse der Omarthroseschulter bei anatomischer Schulterprothesenimplantation

Glenohumeral arthrolysis of the osteoarthritic shoulder in anatomical total shoulder arthroplasty

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Schmerzreduktion und Verbesserung der Gelenkfunktion.

Indikationen

Primäre oder sekundäre Omarthrose, fehlgeschlagene konservative Therapie. Bewegungseinschränkung und Kapselkontraktur.

Kontraindikationen

Allgemeine Kontraindikationen für eine anatomische STEP. Instabilitätsarthrose mit fehlender Kapselkontraktur.

Operationstechnik

Deltoideopektoraler Zugang. Periostnahes Ablösen des M. subscapularis, humeralseitiges Release der anterioren und kaudalen Kapsel, anatomische Kopfresektion und Schaftpräparation. Glenoiddarstellung, Release des M. subscapularis, Resektion der anteroinferioren kontrakten Kapsel, ggf. 360°-Release, Labrumresektion. Glenoidpräparation und Implantation. Auswahl des Humeruskopfs entsprechend der Anatomie ohne Overstuffing. Implantation Originalschaft. Transossäre Refixation des M. subscapularis. Wund- und Hautverschluss.

Nachbehandlung

Abduktionsorthese für 4 Wochen, assistives Bewegungstraining ab dem 1. postoperativen Tag. Bis zur 6. Woche postoperativ Anteversion/Retroversion 90-0-0°, Abduktion/Adduktion 90-0-20° und Innenrotation/Außenrotation 90°-0-individuell erlaubt. Im Anschluss sukzessive Steigerung des Bewegungsumfangs.

Ergebnisse

Zwischen 2009 und 2010 wurde bei 53 Patienten eine STEP mit glenohumeraler Arthrolyse implantiert. Es zeigte sich eine signifikante Verbesserung im Constant-Score und des Bewegungsausmaßes bei einem durchschnittlichen Follow-up von 32 Monaten. Die Komplikationsrate betrug 9 %.

Abstract

Aim of the operation

Pain reduction and improvement of range of motion.

Indications

Primary and secondary osteoarthritis, unsuccessful conservative treatment, limited range of motion with capsular contraction.

Contraindications

General contraindications for anatomical total shoulder arthroplasty. Instability arthritis without capsular contraction.

Operative technique

Deltopectoral approach. Detachment and release of the subscapularis tendon at the lesser tuberosity, incision of the anterior and inferior humeral sided capsule and osteophyte removal, humeral head resection and stem preparation. Glenoid exposure, capsular an labral resection. Glenoid surface preparation and prosthetic component implantation. Anatomical placement of the the humeral head without overstuffing. Implantation of the final humeral stem. Transosseous refixation of the subscapularis tendon. Wound closure.

Follow-up treatment

Abduction brace for 4 weeks. Assisted motion starting the first postoperative day during the first 6 weeks: anteversion/ retroversion 90-0-0°, abduction/ adduction 90-0-20°, internal/external rotation 90-0-individual limitation. Subsequent development of full range of motion.

Results

In 2009 and 2010 anatomical total shoulder arthroplasty with glenohumeral arthrolysis was performed in 53 cases. At an average follow up of 32 months the Constant score and range of motion improved significantly. The complication rate was 9%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13
Abb. 14
Abb. 15
Abb. 16
Abb. 17

Literatur

  1. Bigliani LU, Kelkar R, Flatow EL et al (1996) Glenohumeral stability. Biomechanical properties of passive and active stabilizers. Clin Orthop Relat Res 330:13–30

    Article  PubMed  Google Scholar 

  2. Boileau P, Sinnerton RJ, Chuinard C, Walch G (2006) Arthroplasty of the shoulder. J Bone Joint Surg Br 88:562–575

    Article  CAS  PubMed  Google Scholar 

  3. Boileau P, Walch G (1997) The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br 79:857–865

    Article  CAS  PubMed  Google Scholar 

  4. Cleeman E, Brunelli M, Gothelf T et al (2003) Releases of subscapularis contracture: an anatomic and clinical study. J Shoulder Elbow Surg 12:231–236

    Article  PubMed  Google Scholar 

  5. Constant CR (1997) An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br 79:695–696

    CAS  PubMed  Google Scholar 

  6. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  7. Flatow EL, Bigliani LU, April EW (1989) An anatomic study of the musculocutaneous nerve and its relationship to the coracoid process. Clin Orthop Relat Res 244:166–171

    PubMed  Google Scholar 

  8. Gerber C, Costouros JG, Sukthankar A, Fucentese SF (2009) Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg 18:505–510

    Article  PubMed  Google Scholar 

  9. Habermeyer P, Magosch P, Lichtenberg S (2007) Recentering the humeral head for glenoid deficiency in total shoulder arthroplasty. Clin Orthop Relat Res 457:124–132

    PubMed  Google Scholar 

  10. Hawkins RJ, Bell RH, Jallay B (1989) Total shoulder arthroplasty. Clin Orthop Relat Res 242:188–194

    PubMed  Google Scholar 

  11. Iannotti JP, Gabriel JP, Schneck SL et al (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am 74:491–500

    CAS  PubMed  Google Scholar 

  12. Iannotti JP, Spencer EE, Winter U et al (2005) Prosthetic positioning in total shoulder arthroplasty. J Shoulder Elbow Surg 14:111S–121S

    Article  PubMed  Google Scholar 

  13. Kumar S, Sperling JW, Haidukewych GH, Cofield RH (2004) Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am 86-A:680–689

  14. Lazarus MD, Jensen KL, Southworth C, Matsen FA III (2002) The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am 84-A:1174–1182

  15. Matsen FA III, Rockwood CA Jr, Wirth MA, Lippid S (1998) Glenohumeral arthritis and its management. The Shoulder. 2nd ed. Philadelphia, WB Saunders Company S. 840–964

  16. McFarland EG, Caicedo JC, Guitterez MI et al (2001) The anatomic relationship of the brachial plexus and axillary artery to the glenoid. Implications for anterior shoulder surgery. Am J Sports Med 29:729–733

    CAS  PubMed  Google Scholar 

  17. Neer CS (1974) Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 56:1–13

    PubMed  Google Scholar 

  18. Nyffeler RW, Jost B, Pfirrman CW, Gerber C (2003) Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg 12:493–496

    Article  PubMed  Google Scholar 

  19. Radkowski CA, Richards RS, Pietrobon R, Moorman CT III (2006) An anatomic study of the cephalic vein in the deltopectoral shoulder approach. Clin Orthop Relat Res 442:139–142

    Article  PubMed  Google Scholar 

  20. Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460

    CAS  PubMed  Google Scholar 

  21. Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH (2010) Radiographic stability of ingrowth humeral stems in total shoulder arthroplasty. Clin Orthop Relat Res 468:2122–2128

    Article  PubMed Central  PubMed  Google Scholar 

  22. Walch G, Boileau P, Noel E (2010) Shoulder arthroplasty: evolving techniques and indications. Joint Bone Spine 77:501–505

    Article  PubMed  Google Scholar 

  23. Walch G, Mesiha M, Boileau P et al (2013) Three-dimensional assessment of the dimensions of the osteoarthritic glenoid. Bone Joint J 95-B:1377–1382

  24. Walch G, Moraga C, Young A, Castellanos-Rosas J (2012) Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elbow Surg 21:1526–1533

    Article  PubMed  Google Scholar 

  25. Williams GR Jr, Wong KL, Pepe MD et al (2001) The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement. J Shoulder Elbow Surg 10:399–409

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Struck, M.F. Pastor, A. Gettmann und M. Wellmann geben an, dass kein Interessenkonflikt besteht. T. Smith ist als Berater und Referent für DePuy Synthes tätig. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, hierzu ihre schriftliche Einwilligung gegeben haben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen.

Author information

Authors and Affiliations

  1. Department Schulter-, Knie- und Sportorthopädie, Orthopädische Klinik der Medizinischen Hochschule Hannover, Anna-von-Borries-Str. 1–7, 30625, Hannover, Deutschland

    T. Smith, M.F. Pastor, A. Gettmann, M. Wellmann &  M. Struck

Authors
  1. T. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.F. Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Gettmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Wellmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Struck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Struck.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, T., Pastor, M., Gettmann, A. et al. Glenohumerale Arthrolyse der Omarthroseschulter bei anatomischer Schulterprothesenimplantation. Oper Orthop Traumatol 26, 330–340 (2014). https://doi.org/10.1007/s00064-013-0283-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-013-0283-y

Schlüsselwörter

Keywords

Search

Navigation