Patric Raiss

Zusammenfassung Hintergrund Ziel dieser prospektiven Studie war die Analyse der Ergebnisse des zementfreien Oberflächenersatz des Oberarmkopfes an verschiedenen Pathologien des Schultergelenkes bei Patienten <55 Jahren. Patienten und Methoden Vor und im Mittel 2,5 (1–6) Jahre nach der Operation wurden 23 Patienten (26 Implantate) mit Oberflächenersatzprothesen des Oberarmkopfes untersucht. Zehn Patienten wurden aufgrund einer posttraumatischen Omarthrose und 7 Patienten aufgrund einer primären Omarthrose versorgt. Bei 6 Patienten lag eine Oberarmkopfnekrose vor. Neben dem Constant-Score wurde die Beweglichkeit und die Patientenzufriedenheit evaluiert. Ergebnisse Der mittlere Constant-Score des Gesamtkollektivs konnte signifikant von 33 (8–69) Punkten präoperativ auf 61 (25–83) Punkte postoperativ angehoben werden (p<0,0001). Der alters- und geschlechtsadaptierte Constant-Score verbesserte sich im Mittel von 38% (8–86%) auf 70% (28–114%; p<0,0001). Signifikante Verbesserungen prä- vs. postoperativ wurden für das Gesamtkollektiv für den Schmerz, die Aktivität, die Mobilität, Schulter Flexion, Abduktion und Außen-/Innenrotation gefunden (p<0,001). In einem Fall war ein Wechsel in eine Totalendoprothese aufgrund einer Glenoiderosion und in einem Fall eine weichteilige Reoperation aufgrund eines oberflächigen Wundinfekts notwendig. Schlussfolgerung Der zementfreie Oberflächenersatz des Oberarmkopfes stellt eine knochensparende endoprothetische Therapieoption im Vergleich zur Humeruskopfprothese für junge Patienten dar. Gute klinische Ergebnisse, eine hohe Patientenzufriedenheit und eine relativ niedrige Komplikationsrate konnten gezeigt werden. Langzeituntersuchungen sind notwendig, um diese Ergebnisse zu bestätigen.

The aim of this prospective study was to propose a classification for shoulders with massive rotator cuff defects based on patients’ clinical symptoms. A total of 100 shoulders with massive rotator cuff tears were evaluated clinically using the Constant score (CS) and with radiographs in two planes. Three types were defined and correlated with radiographic findings: (1) the arthritic type (type I), (2) the non-reactive type (type II) and (3) the necrotic type (type III). Significant differences in the overall CS (type I: 28.6 points, range: 4 – 61; type II: 18.8 points, range: 6 – 52; type III: 15.5 points, range: 6 – 31) and its subgroups and in shoulder motion were found between types I and II and between types I and III (p < 0.05). This classification may be helpful for the decision-making process with regard to the appropriate form of shoulder replacement surgery in patients with massive rotator cuff defects.

Background: Osteonecrosis of the humeral head is a disabling condition that can lead to joint destruction with persistent pain and dysfunction. The aim of the present study was to examine cementless humeral surface replacement arthroplasty as a treatment option for posttraumatic and nontraumatic osteonecrosis. Methods: Between 2002 and 2005, seventeen shoulders with posttraumatic (n = 8) or nontraumatic (n = 9) osteonecrosis of the humeral head were treated with cementless humeral replacement arthroplasty. The mean proportion of the humeral head that was occupied by necrotic bone was 18.6% (range, 8.9% to 30.9%). The mean duration of follow-up was three years. Constant scores, patient satisfaction, and complications were recorded. Volumetric measurements of the necrotic areas and signs of implant loosening were analyzed with use of standardized radiographs. Results: The mean Constant score for the entire cohort improved significantly from 31 to 62 points (34% to 75% when adjusted by age and sex) (p < 0.0001). There were also significant improvements in mean shoulder flexion (from 87° to 139°), abduction (from 64° to 120°), and external rotation (from 2° to 27°). The final values for the Constant score, abduction, and power were significantly higher for the nontraumatic group than for the posttraumatic group. Fourteen patients (fifteen shoulders) were very satisfied (eleven shoulders) or satisfied (four shoulders), and two patients (two shoulders) were somewhat disappointed with the postoperative result. Signs of implant loosening were not observed. One patient had a wound infection that required surgical débridement and antibiotic therapy. To date, no implant revisions have been necessary. Conclusions: Cementless humeral surface replacement arthroplasty is a potentially bone-preserving option for patients with posttraumatic and nontraumatic osteonecrosis of the humeral head. Even in the presence of bone loss of as much as 31% of the humeral head, implant loosening was not observed. Good functional results and relief of pain in combination with a low complication rate can be achieved in the short term. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

The aim of this retrospective study was to analyse the clinical, functional and radiographic outcomes of patients sustaining traumatic anterior dislocations of the shoulder in combination with large anterior glenoid rim fractures, treated by open reduction and internal screw fixation (ORIF). Twenty‐nine patients with a mean follow‐up of 6.5 years (2.5–12 years) were evaluated clinically using the Constant and DASH scores, radiographs in two planes and isokinetic muscle strength measurement (Biodex 3 PRO). Mean age was 41.6 years (17–68 years). There was no case of postoperative re‐dislocation. Eight out of 29 patients (27.5%) underwent revision surgery to remove the screws. The mean age‐ and gender‐adjusted Constant score was 93.3% (range 64–102%), and the mean DASH score was 10.1 points (range 0–71 points). On radiological examination, 6 patients had signs of osteoarthritis: Samilson type I (n = 3) and II (n = 3). Significant differences for maximal strength in external rotation and muscular endurance compared to the unaffected side were found (P < 0.035). Twenty‐seven patients (93%) were satisfied or very satisfied with the result after surgery. ORIF seems to be a good treatment option in cases of large glenoid rim fractures to avoid re‐dislocation in the mid‐term. Prospective randomised studies are necessary to compare these findings with those after non‐operative or arthroscopic treatment of these injuries.

Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the supraspinatus tendon occurred. Overall, 20 patients (95%) were either very satisfied (n = 18) or satisfied (n = 2) with the outcome. Significant differences (p < 0.0001) were found for all categories of the Constant and Murley score pre- and post-operatively. The mean Constant and Murley score increased from 24.1 points (10 to 45) to 64.5 points (39 to 93), and the relative score from 30.4% (11% to 50%) to 83% (54% to 116%). No clinical or radiological signs of loosening of the implant were seen. For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term.

The purpose of this prospective study was to describe cementless humeral surface replacement arthroplasty (CHSRA) as a bone preserving treatment option for patients with fixed anterior glenohumeral dislocation. Ten patients with post-traumatic fixed anterior glenohumeral dislocation underwent CHSRA with a mean follow-up of 24 months. All patients were evaluated clinically using the Constant score and with radiographs in two planes. There were two reoperations: one patient developed glenoid erosion and was revised and in another case redislocation occurred. Clinical or radiographical signs of implant loosening were not found. The humeral head centred in the glenoid in nine out of ten cases radiographically. The Constant score increased from 20 points preoperatively to 61 points postoperatively (p < 0.007). CHSRA is a viable treatment option for elderly patients with fixed anterior glenohumeral dislocation and bone defects of the humeral head. Good clinical results and a moderate complication rate were found in the short term.

Ziel: Die dreidimensionale Bewegungsanalyse ist an der unteren Extremität ein seit Jahren bewährtes Mittel zur Therapieplanung. In dieser Studie wurde das Bewegungsausmaß für Schulter und Ellenbogen bei 10 Alltagsbewegungen anhand der 3D-Bewegungsanalyse untersucht. Somit können die Relevanz und das Ausmaß von Bewegungseinschränkungen besser beurteilt werden. Methode: Das verwendete biomechanische Modell der oberen Extremität basierte auf 14 Infrarotlicht reflektierenden Markern. Es wurde standardisiert bei 7 Probanden (Alter 25, SD 15 Jahre) das Bewegungsausmaß des Schulter- und Ellenbogengelenks bei 10 Alltagsbewegungen ermittelt. Die untersuchten Bewegungen waren im Einzelnen: Essen mit einem Löffel, Kämmen mit einem Kamm, Intimhygiene, Telefonieren, Tippen auf einer Tastatur, Trinken aus einem Glas, Drehen eines Schlüssels im Türschloss, Umblättern einer Seite, Wasser in ein Glas eingießen und Zeichnen einer Acht. Ergebnisse: Zur Durchführung von 10 Alltagsbewegungen wurde im Schultergelenk bei der Anteversion/Retroversion ein Bewegungsausmaß von 91 - 0 - 9°, d. h. insgesamt 100°, bei der Abduktion/Adduktion von 112 - 23 - 0° (insgesamt 89°) und eine Außen-/Innenrotation von 91 - 0 - 114° (insgesamt 205°) benötigt. Die meisten Alltagsbewegungen konnten in Außenrotationsstellung durchgeführt werden und ohne die Bewegung Intimhygiene wäre nur eine Innenrotation von 10° nötig gewesen. Der Maximalwert der Anteversion wurde bei der Bewegung Drehung des Schlüssels im Türschloss und der Minimalwert bei der Intimhygiene erreicht. Bei der Abduktion und Rotation wurden der Maximalwert beim Kämmen und der Minimalwert bei der Intimhygiene erreicht. Im Ellenbogen benötigten die Probanden im Mittel ein Bewegungsausmaß bei Extension/Flexion von 0 - 36 - 146° (d. h. insgesamt 110°) und bei Pro- und Supination von 55 - 0 - 72° (insgesamt 127°), wobei die größte Pronation beim „Wasser eingießen“ und die größte Supination bei der Intimhygiene festzustellen war. Schlussfolgerung: Mit der 3D-Bewegungsanalyse können komplex-dynamische Bewegungen und Gelenkwinkel zu jedem beliebigen Zeitpunkt erfasst werden. Durch die Anwendung der 3D-Bewegungsanalyse bei Alltagsbewegungen konnten wir Daten gewinnen, die als Grundlage für das anzustrebende Bewegungsausmaß an der oberen Extremität dienen. Aim: Three-dimensional motion analysis of the lower limb has been an approved method of diagnosis and therapy planning for several years. In this study we observed the range of motion of the shoulder and elbow in 10 activities of daily life (ADL) with a marker-based biomechanical model for the upper extremity. With this database we hope to improve the evaluation of different handicaps of the upper limb. Method: The used biomechanical model is based on 14 infrared light-reflecting markers. The ranges of motion in ADL for shoulder and elbow were measured in a standardised case setting in seven test persons with a mean age of 25 years (SD 15 years). The 10 observed ADL were eating with a spoon, combing hair, genital hygiene, using a telephone, typing on a keyboard, drinking from a glass, turning a key, turning a page, pouring water in a glass and drawing. Results: For the ten explored ADL, the test persons needed a range of motion in the shoulder of 91 - 0 - 9° (total 100°) flexion/extension, 112 - 23 - 0° (total 89°) abduction/adduction, and 91 - 0 - 114° (total 205°) external/internal rotation. Most of the ADL were performed in external rotation and, excluding the motion genital hygiene, the test persons only needed an internal rotation of 10°. Maximal shoulder flexion was used with opening a door, the minimum was reached with genital hygiene. The maximum angles of abduction and rotation were reached with combing hair and the minimum values were reached with genital hygiene. To perform the ADL, an elbow extension/flexion of 0 - 36 - 146° (total 110°), and 55 - 0 - 72° (total 127°) pro-/supination was needed. Maximal pronation was reached with “pour from a pitcher”. Maximal supination was present with genital hygiene. Conclusions: The decisive benefit of 3D motion analysis is the exact capturing of complex and dynamic movements at any time. Therefore, not only static joint positions can be recorded, but also the dynamic course of a movement can be traced. By using our model on every day movements, we were able to collect data that can serve as the basis for the desired range of motion of the upper extremities in patients.