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

Contenido principal del artículo

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

Resumen

ObjetivoAnalizar los resultados funcionales y las complicaciones  a corto plazo de la prótesis reversa de hombro según  diferentes patologías.Materiales y métodosEntre 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.ResultadosEl 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.ConclusiónLa 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 4Abstract 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.

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Bertona Altieri, B. A., Rossi, L., Oñativia, J. I., Tanoira, I., Bongiovanni, S., Maignon, G., & Ranalletta, M. (2017). Resultados a corto plazo de la prótesis invertida de hombro según la patología. [Short-term results of shoulder reversal prosthesis according to pathology]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(4), 278-286. https://doi.org/10.15417/683
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Investigación Clínica
Biografía del autor/a

Bernardo Agustin Bertona Altieri, Hospital Italiano de Buenos Aires

MedicoOrtopedia y Traumatología

Luciano Rossi, Hospital Italiano de Buenos Aires

MédicoOrtopedia y Traumatología

José Ignacio Oñativia, Hospital Italiano de Buenos Aires

MédicoOrtopedia y Traumatología

Ignacio Tanoira, Hospital Italiano de Buenos Aires

MédicoOrtopedia y Traumatología

Santiago Bongiovanni, Hospital Italiano de Buenos Aires

MédicoOrtopedia y Traumatología

Gaston Maignon, Hospital Italiano de Buenos Aires

MédicoOrtopedia y Traumatología

Maximiliano Ranalletta, Hospital Italiano de Buenos Aires

MédicoOrtopedia y TraumatologíaJefe de Sector de HombroHospital Italiano de Buenos Aires

Citas

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