Resultados a corto plazo de la prótesis invertida de hombro según la patología. [Short-term results of shoulder reversal prosthesis according to pathology].

Bernardo Agustin Bertona Altieri, Luciano Rossi, José Ignacio Oñativia, Ignacio Tanoira, Santiago Bongiovanni, Gaston Maignon, Maximiliano Ranalletta

Resumen


Objetivo

Analizar los resultados funcionales y las complicaciones  a corto plazo de la prótesis reversa de hombro según  diferentes patologías.

Materiales y métodos

Entre 2009 y 2013 se realizaron 85 prótesis reversas de hombro. Las indicaciones incluyeron: artropatía por ruptura del manguito rotador, artrosis glenohumeral, fracturas de húmero proximal y artroplastias de revisión. Se evaluaron los pacientes clínica y radiológicamente y se analizaron según los diferentes grupos.

Resultados

El seguimiento promedio fue de 42 meses (26-60) y la edad media 74.5 años (56-90). El Constant mejoró de 16.7 a 62.1 en promedio (P <.001) y el ASES, de 12.7 a 68.8 en promedio (P <.001). La elevación aumentó de 80.5 °a 111.5° (P <.001). No hubo mejoría significativa en la rotación interna ni externa. Sesenta pacientes (78,9 %) refirieron estar muy satisfechos/satisfechos. En 22 pacientes (27.8%) se hallaron muescas en el borde inferior de la glena. La tasa de complicaciones fue del 20%, siendo mas frecuentes en el grupo de fracturas y artroplastias de revisión.

Conclusión

La prótesis reversa de hombro mejora significativamente los scores funcionales, flexion anterior y abducción, independientemente de la indicación quirurgica. Presenta limitaciones con respecto a la rotacion externa e interna en el postoperatorio. Es una alternativa valida en multiples patologías de hombro, sin embargo presenta un elevado índice de complicaciones, por lo que su indicacion debe ser precisa, especialmente en pacientes a ser tratados por fracturas o en cirugias de revisión.

 

Nivel de evidencia 4


Abstract

Objective:  The purpose of this study is to analyze the short-term functional results and complications of the reverse shoulder prosthesis according to different etiologies.

Methods: Between 2009 and 2013, 85 reverse shoulder arthroplasties were performed. Surgical indications included: rotator cuff tear artropathy, glenohumeral osteoarthritis, proximal humeral fractures and revision arthroplasty. Patients were clinically and radiologically evaluated and analyzed in different groups.

Results: The mean follow-up was 42 months (range 26-60) and the mean age was 74.5 years (range 56-90). Constant score improved from 16.7 to 62.1 on average (p<.001) while ASES score improved from 12.7 to 68.8 on average (p<.001). Elevation increased from 80.5° to 111.5° (p<.001). There was no significant improvement in internal and external rotation. Sixty patients (78.9%) were very satisfied/satisfied. A total of 22 patients (27.8%) had notches in the inferior rim of the glenoid. Complication rate was 20%, being more frequent in the group of fractures and revision arthroplasties.

Conclusions: The reverse shoulder arthroplasty significantly improved functional scores, anterior flexion and abduction, regardless of surgical indication. It has limitations with respect to the external and internal rotation postoperatively. It is a valid alternative in multiple shoulder conditions; however, complication rate is high, so the indication should be accurate, especially in patients treated for fractures or in revision surgeries.


Palabras clave


protesis reversa de hombro; resultados a corto plazo; complicaciones.Reverse shoulder prosthesis, short term results, complications.

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Referencias


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DOI: http://dx.doi.org/10.15417/683

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Registro de la Propiedad Intelectual Nº 5353562 (en línea).

ISSN 1852-7434 (en línea).

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