Skip to main content
SpringerLink
Log in

Mananagement von Glenoiddefekten in der Schulterprothetik

Knochentransplantation oder metallische Augmentation

Management of glenoid bone defects in shoulder arthroplasty

Bone grafts and metallic augmentation

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Bei Vorliegen schwerer Glenoiddefekte stellt die Implantation einer anatomischen Schultertotalendoprothese (TSA) oder einer inversen Schulterprothese (RSA) eine Herausforderung dar. Mit zunehmender Fallzahl im Bereich der Endoprothetik wird der behandelnde Schulterchirurg nicht nur mit Primärfällen (degenerativ, angeboren, rheumatoid, posttraumatisch), sondern auch mit komplexen Revisionsfällen oder höhergradigen Glenoiddeformitäten bzw. -defekten konfrontiert. Neben der klassischen Röntgenaufnahme stellt die Computertomographie (CT) mit 2‑ und 3‑dimensionaler Rekonstruktion das Standardverfahren zum Verständnis und zur Analyse der Defektsituationen dar. Die Knochenqualität, Art und Ausmaß der Subluxation des Humerus sowie die vorhandenen Weichteilverhältnisse sind weitere wichtige Parameter für die diagnostischen Überlegungen. In den letzten Jahren wurde durch die Einführung von verbesserten Implantatsystemen auch ein Ausgleich größerer Defekte durch Knochengrafts mit gleichzeitiger stabiler Verankerung von Glenoid-Basisplatten möglich, wodurch in vielen Fällen der Einsatz funktionell deutlich besserer inverser Prothesen im Vergleich zur alleinigen Hemiprothese ermöglicht wird. Alternativ zum Aufbau der Glenoiddefekte durch Knochenspäne stehen zunehmend augmentierte metallische Glenoidimplantate zur Verfügung, welche entweder vorgefertigt sind oder speziell angepasst auf die individuelle Defektsituation des Patienten entwickelt und gefertigt werden. In diesem Beitrag werden anhand einiger Fälle die Prinzipien des Defektaufbaus des Glenoids mit Knochengraft und/oder patientenspezifischer metallischer Augmentation vorgestellt.

Abstract

Total (TSA) or reverse total shoulder arthroplasty (RSA) for severe glenoid defects is a well-known challenge. With an increasing number of cases in the field of endoprosthetics, the treating surgeon is confronted not only with primary cases (degenerative, congenital, rheumatoid, posttraumatic) but also with complex revision procedures or higher grade glenoid deformities and defects. Besides conventional X‑ray imaging, computer tomography (CT) with 2‑dimensional and 3‑dimensional reconstructions is the standard procedure for understanding and analyzing the defect situation. In addition to the bone quality, the type and extent of humeral subluxation and soft tissue conditions are further important parameters for the diagnostic deliberations. In recent years improved instruments and modern implant systems have been introduced, which enable sufficient treatment of larger defects by bone grafting, while providing a stable implantation of glenoid base plates. Using these new technologies, in many cases the use of functionally clearly better reverse arthroplasty is possible, thus rendering superior outcomes compared to hemiarthroplasty. As an alternative to reconstruction of glenoid defects with bone grafts, modern augmented metallic glenoid implants are available. They are either prefabricated or custom-made and manufactured based on the specific bony defect or situation of the patient. This article presents the principles of defect reconstruction of the glenoid with bone grafting and custom-made metallic augmentation.

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
Abb. 18
Abb. 19
Abb. 20
Abb. 21

Literatur

  1. Antuna SA, Sperling JW, Cofield RH et al (2001) Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 10(3):217–224

    Article  CAS  Google Scholar 

  2. Bacle G, Nove-Josserand L, Geraud P, Walch G (2017) Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg. https://doi.org/10.2106/JBJS.16.00223

    Article  PubMed  Google Scholar 

  3. Berhouet J, Gulotta LV, Dines DM, Craig E, Warren RF, Choi D, Kontaxis A et al (2017) Preoperative planning for accurate glenoid component positioning in reverse shoulder arthroplasty. Orthop Traumatol Surg Res 103(3):407–413. https://doi.org/10.1016/j.otsr.2016.12.019

    Article  CAS  PubMed  Google Scholar 

  4. Boileau P, Morin-Salvo N, Gauci M‑O et al (2017) Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management of glenoid bone loss and erosion. J Shoulder Elbow Surg 26:2133–2142. https://doi.org/10.1016/j.jse.2017.05.024

    Article  PubMed  Google Scholar 

  5. Boileau P, Moineau G, Roussanne Y, O’Shea K (2017) Bony increased offset-reversed shoulder arthroplasty (BIO-RSA). JBJS Essent Surg Tech 7(4):e37. https://doi.org/10.2106/jbjs.st.17.00006

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chalmers PN, Keener JD (2016) Expanding roles for reverse shoulder arthroplasty. Curr Rev Musculoskelet Med. https://doi.org/10.1007/s12178-016-9316-0

    Article  PubMed  PubMed Central  Google Scholar 

  7. De Martino I, Dines DM, Warren RF et al (2018) Patient-specific implants in severe glenoid bone loss. Am J Orthop. https://doi.org/10.12788/ajo.2018.0009

    Article  PubMed  Google Scholar 

  8. Eraly K, Stoffelen D, Vander Sloten J et al (2016) A patient-specific guide for optimizing custom-made glenoid implantation in cases of severe glenoid defects: an in vitro study. J Shoulder Elbow Surg 25:837–845. https://doi.org/10.1016/j.jse.2015.09.034

    Article  PubMed  Google Scholar 

  9. Franceschetti E, Ranieri R, Giovanetti de Sanctis E, Palumbo A, Franceschi F (2019) Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.05.023

    Article  PubMed  Google Scholar 

  10. Gauci MO, Boileau P, Baba M, Chaoui J, Walch G (2016) Patient-specific glenoid guides provide accuracy and reproducibility in total shoulder arthroplasty. Bone Joint J 98-B(8):1080–1085. https://doi.org/10.1302/0301-620x.98b8.37257

    Article  CAS  PubMed  Google Scholar 

  11. Ghafurian S, Galdi B, Bastian S et al (2016) Computerized 3D morphological analysis of glenoid orientation. J Orthop Res. https://doi.org/10.1002/jor.23053

    Article  PubMed  Google Scholar 

  12. Goriainov V, McEwan JK, Oreffo RO, Dunlop DG (2018) Application of 3D-printed Patient specific skeletal implants augmented with autologous skeletal stem cells. Regen Med 13:283294. https://doi.org/10.2217/rme-2017-0127

    Article  CAS  Google Scholar 

  13. Grammont PM, Baulot E (2011) The classic: Delta shoulder prosthesis for rotator cuff rupture. Clin Orthop Relat Res 469:2424. https://doi.org/10.1007/s11999-0111960-5

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gupta A, Thussbas C, Koch M, Seebauer L (2018) Management of glenoid bone defects with reverse shoulder arthroplasty—surgical technique and clinical outcomes. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2017.10.004

    Article  PubMed  Google Scholar 

  15. Hafez MA, Moholkar K (2017) Patient-specific instruments: advantages and pitfalls. SICOT‑J. https://doi.org/10.1051/sicotj/2017054

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harmsen S, Casagrande D, Norris T (2017) “Shaped” humeral head autograft reverse shoulder arthroplasty. Orthopäde 46(12):1045–1054. https://doi.org/10.1007/s00132-017-3497-0

    Article  CAS  PubMed  Google Scholar 

  17. Heylen S, Van Haver A, Vuylsteke K, Declercq G, Verborgt O (2016) Patient-specific instrument guidance of glenoid component implantation reduces inclination variability in total and reverse shoulder arthroplasty. J Shoulder Elbow Surg 25(2):186–192. https://doi.org/10.1016/j.jse.2015.07.024

    Article  PubMed  Google Scholar 

  18. Ho JC, Thakar O, Chan WW, Nicholson T, Williams GR, Namdari S (2019) Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.07.035

    Article  PubMed  Google Scholar 

  19. Iannotti JP, Walker K, Rodriguez E et al (2017) Three-dimensional preoperative planning and patients specific instrumentation improve glenoid component positioning. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2017.06.011

    Article  PubMed  Google Scholar 

  20. Knudsen ML, Irvine JN, Jobin CM (2018) Complications of reverse shoulder arthroplasty. Semin Arthroplasty. https://doi.org/10.1053/j.sart.2018.10.007

    Article  Google Scholar 

  21. Mahylis JM, Puzzitiello RN, Ho JC, Amini MH, Iannotti JP, Ricchetti ET (2018) Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2018.06.026

    Article  PubMed  Google Scholar 

  22. Malhas AM, Granville-Chapman J, Robinson PM, Brookes-Fazakerley S, Walton M, Monga P, Trail I et al (2018) Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal-backed prosthesis. Bone Joint J 100-B(12):1609–1617. https://doi.org/10.1302/0301-620x.100b12.bjj-2018-0494.r1

    Article  CAS  PubMed  Google Scholar 

  23. Maniar RN, Singhi T (2014) Patient specific implants: scope for the future. Curr Rev Musculoskelet Med 7:125–130. https://doi.org/10.1007/s12178-014-9214-2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Parthasarathy J (2014) 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg 4:9–18. https://doi.org/10.4103/22310746.133065

    Article  PubMed  PubMed Central  Google Scholar 

  25. Scarlat MM (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop. https://doi.org/10.1007/s00264-013-1832-6

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schmauder P, Kraus T, Küper MA, Ziegler P, Ateschrang A, Stöckle U, Freude T (2019) Custom-made-Glenoidkomponente via 3D-Print. Orthopäde. https://doi.org/10.1007/s00132-019-03841-3

    Article  Google Scholar 

  27. Seidl AJ, Williams GR, Boileau P (2016) Challenges in reverse shoulder arthroplasty: addressing glenoid bone loss. Orthopedics 39(1):14–23. https://doi.org/10.3928/01477447-20160111-01

    Article  PubMed  Google Scholar 

  28. Stoffelen DVC, Eraly K, Debeer P (2015) The use of 3D printing technology in reconstruction of a severe glenoid defect: a case report with 2.5 years of follow-up. J Shoulder Elbow Surg 24(8):e218–e222. https://doi.org/10.1016/j.jse.2015.04.006

    Article  PubMed  Google Scholar 

  29. Terrier A, Ston J, Larrea X, Farron A (2014) Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders. Bone Joint J 96–B:513–518. https://doi.org/10.1302/0301-620X.96B4.32641

    Article  PubMed  Google Scholar 

  30. Villatte G, Muller A‑S, Pereira B, Mulliez A, Reilly P, Emery R (2018) Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis. PLoS ONE 13(8):e201759. https://doi.org/10.1371/journal.pone.0201759

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Walch G, Boulahia A, Boileau P, Kempf JF (1998) Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group. Acta Orthop Belg 64(Suppl 2):46–52

    PubMed  Google Scholar 

  32. Walch G, Vezeridis PS, Boileau P et al (2015) Three-dimensional planning and use of patient-specific guides improve glenoid component position: An in vitro study. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2014.05.029

    Article  PubMed  Google Scholar 

  33. Williams GR, Iannotti JP (2007) Options for glenoid bone loss: composites of prostheticsand biologics. J Shoulder Elbow Surg 2007:267S–272S

    Article  Google Scholar 

  34. Bercik MJ, Kruse K, Yalizis M, Gauci M‑O, Chaoui J, Walch G (2016) A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 25(10):1601–1606

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gelenkchirurgie Orthopädie Hannover go:H, Bertastr. 10, 30159, Hannover, Deutschland

    I.-A. Popescu, T. Vogelsang &  J. Agneskirchner

  2. European Shoulder & Hand Unit, Bukarest, Rumänien

    I.-A. Popescu

Authors
  1. I.-A. Popescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Vogelsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Agneskirchner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Agneskirchner.

Ethics declarations

Interessenkonflikt

I.-A. Popescu, T. Vogelsang und J. Agneskirchner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Caption Electronic Supplementary Material

Die Online-Version dieses Beitrags (https://doi.org/10.1007/s00142-020-00367-1) enthält ein Re-Live OP Video: Implantation einer patientenzpezifischer inverse Schulterprothese

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Popescu, IA., Vogelsang, T. & Agneskirchner, J. Mananagement von Glenoiddefekten in der Schulterprothetik. Arthroskopie 33, 354–369 (2020). https://doi.org/10.1007/s00142-020-00367-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00142-020-00367-1

Schlüsselwörter

Keywords

Search

Navigation