Ters omuz protezi: Kısa dönem radyolojik ve klinik sonuçlarımız

Öz

Amaç: Bu çalışmada rotator manşet yırtığı artropatisi sebebiyle ters omuz protezi uyguladığımız hastalarımızın kısa dönem radyolojik ve klinik sonuçlarını incelemeyi amaçladık. Çalışma planı: 2009–2010 tarihleri arasında manşet yırtığına bağlı omuz artrozu olan 2 erkek, 12 kadın toplam 14 hastaya ters omuz protezi uygulandı. Hastaların ortalama yaşı 74 yıl (57–80) ve ortalama takip süresi 32 ay (21–40) idi. Hastalar ameliyat öncesinde ve son kontrollerinde radyolojik yöntemlerle ve eklem hareket açıklığı, Quick DASH, Constant, VAS skorları ile değerlendirildi. Bulgular: Ameliyat öncesi ortalama sırasıyla 44, 41 ve 21 derece olan aktif öne fleksiyon, abdüksiyon ve dış rotasyon dereceleri son kontrollerinde sırasıyla ortalama 149, 105 ve 37 derece olarak ölçüldü. Ortalama Quick DASH skoru ameliyat öncesi 59.1 iken son kontrollerinde 36.1 olduğu izlendi. Ortalama Constant skoru ameliyat öncesi 20.7 iken son kontrollerinde 58.9’a yükseldi. VAS değerlendirmesi ameliyat öncesi ortalama 7 iken son kontrollerinde 1.2’ye geriledi. Akromion humerus arası mesafe ölçümleri ameliyat öncesi ortalama 5.3 iken ameliyat sonrası ortalama 23.1’e yükseldi. Hastaların hiçbirinde erken ve geç büyük komplikasyon izlenmedi. Çıkarımlar: İleri evredeki rotator manşet yırtığı artropatisi hastalarında ters omuz protezi uygulaması ve uygun rehabilitasyon protokolü ile ağrı ve fonksiyon açısından anlamlı düzelme sağlanabilir.

Anahtar Kelimeler

• Ters omuz artroplastisi; rotator manşet yırtığı.

Reverse shoulder arthroplasty: radiological and clinical short–term results

Abstract

Objective: The aim of this study was to examine the radiological and clinical short term results of the patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy.
Methods: The study included 14 (2 male, 12 female) patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy between 2009 and 2010. The mean age of the patients was 74 (57–80) years and the mean follow–up period was 32 (21–40) months. Radiological methods as well as the range of motion, Quick DASH, Constant and VAS scores were used for the evaluation of patients preoperatively and at last the follow–up.
Results: Mean active forward flexion, abduction and external rotation increased respectively from 44, 41 and 21 degrees preoperatively to 149, 105 and 37 degrees at the last follow–up. The mean QuickDash score was 59.1 degrees preoperatively, and 36.1 degrees at the last follow–up visit. The mean Constant score increased from 20.7 preoperatively to 58.9 at the last follow–up visit. The mean VAS score decreased from 7 preoperatively to 1.2 at the last follow–up visit. The mean acromion–humeral head distance increased from 5.3 mm preoperatively to 23.1 mm postoperatively. None of the patients had major complications.
Conclusion: Reverse shoulder arthroplasty in patients with advanced stage rotator cuff tear arthropathy ensure significant improvement in terms of pain and function with the help of an appropriate rehabilitation protocol.

Keywords

• Reverse shoulder
• arthroplasty
• rotator cuff tear

Kaynakça

1. Neer CS 2nd, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am 1983;65:1232-44.
2. Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-andsocket total shoulder prosthesis. J Bone Joint Surg Am 2005;87:1476-86. CrossRef
3. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr. Débridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 1995;77:857-66.
4. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res 2001;390:107-18. CrossRef
5. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty 1988;3:39-46.
6. Williams GR Jr, Rockwood CA Jr. Hemiarthroplasty in rotator cuff-deficient shoulders. J Shoulder Elbow Surg 1996;5:362-7. CrossRef
7. Worland RL, Jessup DE, Arredondo J, Warburton KJ. Bipolar shoulder arthroplasty for rotator cuff arthropathy. J Shoulder Elbow Surg 1997;6:512-5. CrossRef
8. Cofield RH. Shoulder arthrodesis and resection arthroplasty. Instr Course Lect 1985;34:268-77.

9. Leung B, Horodyski M, Struk AM, Wright TW. Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. J Shoulder Elbow Surg 2012;21:319-23. CrossRef
10. Field LD, Dines DM, Zabinski SJ, Warren RF. Hemiarthroplasty of the shoulder for rotator cuff arthropathy. J Shoulder Elbow Surg 1997;6:18-23. CrossRef
11. Zuckerman JD, Scott AJ, Gallagher MA. Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg 2000;9:169-72. CrossRef
12. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006;88:1742-7. CrossRef
13. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993;16:65-8.
14. Matsen FA 3rd, Boileau P, Walch G, Gerber C, Bicknell RT. The reverse total shoulder arthroplasty. J Bone Joint Surg Am 2007;89:660-7.
15. Melis B, Bonnevialle N, Neyton L, Lévigne C, Favard L, Walch G, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg 2012;21:342-9. CrossRef
16. Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89:1476-85. CrossRef
17. Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 2007;89:516-20. CrossRef
18. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 2006;15:527-40. CrossRef Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A longterm observation. Clin Orthop Relat Res 1990;254:92
19. Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg 2009;18:600-6. CrossRef
20. Young AA, Smith MM, Bacle G, Moraga C, Walch G. Early results of reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am 2011;93:1915-23. CrossRef
21. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86:388-95. CrossRef
22. Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience? J Shoulder Elbow Surg 2012;21:1470 CrossRef
23. Boileau P, Rumian AP, Zumstein MA. Reversed shoulder arthroplasty with modified L’Episcopo for combined loss of active elevation and external rotation. J Shoulder Elbow Surg 2010;19(2 Suppl):20-30. CrossRef
24. Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R. Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res 2011;469:3324-31. CrossRef
25. Khan WS, Longo UG, Ahrens PM, Denaro V, Maffulli N. A systematic review of the reverse shoulder replacement in rotator cuff arthropathy, rotator cuff tears, and rheumatoid arthritis. Sports Med Arthrosc 2011;19:366-79. CrossRef
26. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 2011;19:439-49.
27. Lévigne C, Boileau P, Favard L, Garaud P, Molé D, Sirveaux F, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2008;17:925-35. CrossRef
28. Mizuno N, Denard PJ, Raiss P, Walch G. The clinical and radiographical results of reverse total shoulder arthroplasty with eccentric glenosphere. Int Orthop 2012;36:1647 CrossRef
29. Klein SM, Dunning P, Mulieri P, Pupello D, Downes K, Frankle MA. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am 2010;92:1144-54.