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Lin J, Song G, Huang A, Hu J, Tang Q, Lu J, Huang Y, Gong M, Zhu X, Wang J. Design and validation of a novel 3D-printed glenohumeral fusion prosthesis for the reconstruction of proximal humerus bone defects: a biomechanical study. Front Bioeng Biotechnol 2024; 12:1428446. [PMID: 39040498 PMCID: PMC11260710 DOI: 10.3389/fbioe.2024.1428446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Background All available methods for reconstruction after proximal humerus tumor resection have disadvantages, and the optimal reconstruction method remains uncertain. This study aimed to design a novel 3D-printed glenohumeral fusion prosthesis and verify its feasibility and safety using biomechanical methods. Methods We verified the feasibility and safety of the 3D-printed glenohumeral fusion prosthesis by finite element analysis and biomechanical experimentation. In the finite element analysis, three reconstruction methods were used, and displacement and von Mises stress were observed; on this basis, in the biomechanical experiment, models constructed with sawbones were classified into two groups. The force‒displacement curve of the 3D-printed prosthesis was evaluated. Results In terms of displacement, the finite element analysis showed greater overall stability for the novel prosthesis than traditional glenohumeral joint arthrodesis. There was no obvious stress concentration in the internal part of the 3D-printed glenohumeral fusion prosthesis; the stable structure bore most of the stress, and the force was well distributed. Adding lateral plate fixation improved the stability and mechanical properties of the prosthesis. Furthermore, the biomechanical results showed that without lateral plate fixation, the total displacement of the prosthesis doubled; adding lateral plate fixation could reduce and disperse strain on the glenoid. Conclusion The design of the 3D-printed glenohumeral fusion prosthesis was rational, and its stability and mechanical properties were better than those of traditional glenohumeral joint arthrodesis. Biomechanical verification demonstrated the feasibility and safety of this prosthesis, indicating its potential for proximal humerus bone defect reconstruction after tumor resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaojun Zhu
- Department of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jin Wang
- Department of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
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2
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Labrum JT, de Marinis R, Atwan Y, Marigi EM, Houdek MT, Barlow JD, Morrey ME, Sanchez-Sotelo J, Sperling JW. Reverse shoulder arthroplasty megaprosthesis for surgical management of severe proximal humeral bone loss. J Shoulder Elbow Surg 2024; 33:S64-S73. [PMID: 38360352 DOI: 10.1016/j.jse.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Shoulder arthroplasty in the setting of severe proximal humerus bone loss can be challenging. The purpose of this study was to evaluate the outcomes of a modular segmental megaprosthesis when implanted in a reverse configuration for complex primary arthroplasty, reconstruction at the time of oncologic resection, and revision shoulder arthroplasty. MATERIALS AND METHODS A Joint Registry Database was queried to identify all shoulder arthroplasties performed at a single institution using the Comprehensive Segmental Revision System reverse shoulder arthroplasty (SRS-RSA; Zimmer Biomet). A retrospective review of electronic medical records and radiographs was performed to record demographic data, indication, outcomes, complications, and revision surgery. RESULTS Between February 2012 and October 2022, a total of 76 consecutive SRS-RSAs were implanted. An analysis of patients with minimum 12-month follow-up yielded 53 patients with a mean follow-up of 4.1 ± 2.43 years. Surgical complication rate in this cohort was observed in 41.5% (22 of 53) of cases. Overall, the revision rate at final follow-up was 26.4% (14 of 53), with a significant difference between the primary and revision cohorts. The number of prior surgeries was a significant risk factor for revision surgery, with a hazard ratio of 1.789 (95% confidence interval 1.314-2.436, P < .001). When analyzing aseptic humeral loosening rates across study cohorts, a significant difference was found between the primary arthroplasty (0%, n = 0) and the revision arthroplasty cohorts (22.2%, n = 6) (P = .04). DISCUSSION Reverse shoulder arthroplasty using a modular segmental megaprosthesis remains a reasonable salvage option for shoulder reconstruction in the setting of proximal humeral bone loss. Because of the substantial bone loss and soft tissue deficiencies typically present in these cases, surgeons should educate patients on the relatively high complication rate, particularly when used in the setting of a previous failed arthroplasty.
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Affiliation(s)
- Joseph T Labrum
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo de Marinis
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile; Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile
| | - Yousif Atwan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Erick M Marigi
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Mark E Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Amouyel T, Szymanski C, Rodrigues V, Saab M, Maynou C. Poor clinical outcomes and high rates of dislocation after modular reverse shoulder arthroplasty for proximal humeral oncologic resection. INTERNATIONAL ORTHOPAEDICS 2024; 48:1331-1339. [PMID: 38403733 DOI: 10.1007/s00264-024-06122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The shoulder is the most common site for upper extremity tumors. The aim of the study was to analyze the outcomes and the complications of modular reverse shoulder arthroplasty (RSA) after proximal humerus resection. METHODS We retrospectively included 15 consecutive patients who underwent a modular MUTARS™ RSA reconstruction after proximal humerus tumour resection between 2017 and 2020. The mean age was 52 years. Their clinical outcomes were assessed using the Constant-Murley score and the MSTS shoulder. Radiological outcomes were assessed based on the presence of loosening, osteolysis, and scapular notching. Complications such as dislocation, oncological recurrence, and infection were assessed. Mean follow-up time was 32.9 months (24 to 45). RESULTS The mean adjusted Constant score was 50.7% (min 22, max 81), and the mean MSTS score was 15.6 (min 4, max 26). We had no loosening, osteolysis, or scapular notching on the radiographs at last follow-up. We had a high complication rate of 53%: one infection, one oncological recurrence, and six dislocations (40%), of which five were re-operated. CONCLUSION In our experience, the MUTARS™ Implantcast™ modular RSA has poor functional results and a high rate of dislocation in the case of large proximal humerus resections below the distal insertion of the deltoid.
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Affiliation(s)
- Thomas Amouyel
- UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, CHU Lille, Service d'orthopédie 1, 59000, Lille, France.
| | - Christophe Szymanski
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
| | - Valentin Rodrigues
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Carlos Maynou
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
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4
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Morea V, Polizzi A, Niccoli G, Zattoni G, Andriollo L. Reverse Shoulder Megaprosthesis for Massive Proximal Humeral Bone Loss in Fracture Outcome Settings: A Report of Two Cases and Literature Review. Cureus 2024; 16:e54276. [PMID: 38496105 PMCID: PMC10944564 DOI: 10.7759/cureus.54276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
In trauma settings, including the management of outcomes, there is no consensus on the most appropriate reconstructive method in the presence of severe bone loss of the proximal humerus. The objective of this report is to evaluate the short-term functional outcomes of two patients in whom reverse shoulder megaprosthesis was used to treat the failure of trauma surgery with severe bone loss. The secondary objective was to compare the results obtained with the literature regarding the use of megaprosthesis in shoulder trauma surgery. The patients showed a satisfying functional recovery and increased quality of life. At the 12-month follow-up, no complications occurred. Regarding the risk of complications, especially the risks of mobilization of the megaprosthesis, the CT-based intraoperative navigation system optimizes the configuration of the screw for the initial fixation of the glenoid component. Shoulder megaprosthesis appears to be a viable option not only in oncologic surgery but also in cases of failed trauma surgery. The functional results, considering functional score and range of motion, are encouraging and allow patients to improve their quality of life.
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Affiliation(s)
- Vincenzo Morea
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, Brescia, ITA
| | - Alberto Polizzi
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, Brescia, ITA
| | - Giuseppe Niccoli
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, Brescia, ITA
| | - Guido Zattoni
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, Brescia, ITA
| | - Luca Andriollo
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, Brescia, ITA
- Department of Orthopedics, Università Cattolica del Sacro Cuore, Rome, ITA
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Lesensky J, Belzarena AC, Daniel M. Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection. World J Surg Oncol 2023; 21:295. [PMID: 37723520 PMCID: PMC10506192 DOI: 10.1186/s12957-023-03173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hindering also function of the elbow and hand, whereas constrained shoulder reconstructions suffer from early aseptic loosening of the glenoid component due to bone overload. The purpose of this study was to develop a constrained implant suitable for extra-articular resection with loss of function in deltoid and rotator cuff, which would provide both stability and passive motion, whilst also decreasing the risk of aseptic loosening of the glenoid component. METHODS In cooperation with Czech Technical University in Prague, we devised an implant consisting of two constrained joints in series connected by a dumbbell piece. The biomechanical analysis showed a reduction of load transfer to the glenoid component with a torque of 8.6 Nm capable of generating an 865-N pulling force on bone screw to just 0.07 Nm, hence shielding the glenoid component from undesired forces and decreasing the risk of aseptic loosening. Three patients with extra-articular resection with a total loss of function of both rotator cuff and deltoid muscle received this type of reconstruction. The average follow-up was 16 months. RESULTS The surgical technique is straightforward. The surgery took 175 min on average with average blood loss of 516 ml. There were no surgical- or implant-related complications. All three patients were pain-free and had a stable shoulder joint after the reconstruction. All had fully functional elbow, wrist, and hand joints. The average Musculoskeletal Tumor Society (MSTS) score was 21/30 (70%). All patients were pleased with the results. CONCLUSION The presented innovative implant design has demonstrated to be a promising alternative for reconstruction in these challenging cases.
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Affiliation(s)
- Jan Lesensky
- Department of Orthopaedics, First Medical Faculty, University Hospital Na Bulovce, Charles University, Prague, Czech Republic.
| | - Ana C Belzarena
- Department of Orthopedic Surgery, University of Missouri, Columbia, USA
| | - Matej Daniel
- Department of Mechanics, Biomechanics, and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Kawanami K, Kajita Y, Harada Y, Takahashi E, Deie M. Bone metastasis of proximal humerus treated by reverse shoulder arthroplasty with polyester mesh: A case report. J Orthop Sci 2023; 28:1175-1178. [PMID: 33419626 DOI: 10.1016/j.jos.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Katsuhisa Kawanami
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Japan.
| | - Emiko Takahashi
- Department of Pathology, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
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Bota O, Dragu A, Bönke F, Tille E, Taqatqeh F, Nowotny J. Complex Functional Posttraumatic Shoulder Reconstruction Using Shoulder Arthroplasty and a Pedicled Innervated Latissimus Dorsi Flap-A Case Report and Literature Review. Orthop Surg 2023; 15:2181-2186. [PMID: 36411538 PMCID: PMC10432418 DOI: 10.1111/os.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction. CASE PRESENTATION We present the case of a 16-year-old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain. CONCLUSION The pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.
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Affiliation(s)
- Olimpiu Bota
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Adrian Dragu
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Florian Bönke
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Eric Tille
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Feras Taqatqeh
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Jörg Nowotny
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
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Denissen JJPM, Koenders N, van Hinte G, Groen F, van der Wees PJ, van der Geest ICM, Dierselhuis EF. Functional outcomes after reversed shoulder megaprosthesis following resection of malignant bone tumor in the proximal humerus: a systematic review and meta-analysis. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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9
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Gohlke F, Berner A, Abdelkawi A. [Humeral bone defects in revision shoulder arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:98-108. [PMID: 36651969 DOI: 10.1007/s00132-022-04335-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Revision shoulder arthroplasty is mainly performed with reverse TSA and should consider proper adjustment of the length and the amount of bone loss in humeral reconstruction. Whilst epi-/metaphyseal bone loss can mostly be compensated easily by stemmed standard implants, advanced bone loss exceeding 2° requires the support of longer revision stems. EXTENSIVE HUMERAL BONE LOSS Cementless fixation in the intact diaphyseal humerus is recommended in bone loss exceeding 2°, preferably with modular revision systems, because cemented reverse revision stems have higher loosening rates in the mid to long-term follow-up. In cases of advanced bone loss 3°-4° (more than 6-7 cm), structural humeral allografts should be considered to prevent instability and early loosening. Unfortunately, the access to fresh frozen allografts is very limited due to regulation of the German government in contrast to the situation in the US or Switzerland. Reverse tumor arthroplasty is an option with a higher complication rate and inferior function even when polyester mesh is used for ingrowth of soft tissues. DISTINCT DIAPHYSEAL DEFECTS In bone loss 4°-5° the minimal anchorage length is mostly critical due to the curvature of the medullary canal. The fixation of a revision stem is only possible when at least 2-3 widths of the diaphyseal diameter are available. Custom-made implants with flanges or distal locking screws, or bipolar tumor arthroplasty may be required. Additionally, strut allografts can be useful to achieve stable fixation. Two-stage biological reconstruction in impaction-bone-graft or the Masquelet technique are rarely used as a salvage procedure.
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Affiliation(s)
- Frank Gohlke
- Klinik für Orthopädie, Unfallchirurgie, Schulter- und Ellenbogenchirurgie und Endoprothetik, Rhön-Klinikum, Campus Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland.
| | - Arne Berner
- Klinik für Orthopädie, Unfallchirurgie, Schulter- und Ellenbogenchirurgie und Endoprothetik, Rhön-Klinikum, Campus Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland
| | - Ayman Abdelkawi
- Klinik für Orthopädie, Unfallchirurgie, Schulter- und Ellenbogenchirurgie und Endoprothetik, Rhön-Klinikum, Campus Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland
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Han J, Kim WL, Kim Y, Cho HS, Oh JH. Does reverse total shoulder arthroplasty with allograft-prosthesis composite (APC) have surgical benefits over hemiarthroplasty with APC in patients with tumors of the proximal humerus? Jpn J Clin Oncol 2022; 52:1408-1415. [DOI: 10.1093/jjco/hyac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/25/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
The research on surgical outcomes of hemiarthroplasty and reverse total shoulder arthroplasty using allograft-prosthesis composites for the proximal humeral oncologic condition is still scarce. Therefore, this study aimed to compare surgical outcomes of shoulder joint reconstruction with hemiarthroplasty and reverse total shoulder arthroplasty using allograft-prosthesis composites for tumors of the proximal humerus.
Methods
Eleven patients underwent hemiarthroplasty or reverse total shoulder arthroplasty using allograft-prosthesis composites for tumors of the proximal humerus between July 2011 and April 2018 were reviewed. Radiographic analysis for bone union of allograft-host bone junction, implant loosening, stress shielding and shoulder dislocation or subluxation was performed. Functional outcomes were evaluated using visual analog scales for pain, range of motion, Simple Shoulder Test score and Musculoskeletal Tumor Society score. Furthermore, oncologic outcome and complications were also assessed, respectively.
Results
There were five patients with hemiarthroplasty (mean age, 23.2 years) and six patients with reverse total shoulder arthroplasty (mean age, 46.8 years, P = 0.05). Radiographically, there were no events associated with implant loosening, stress shielding and shoulder dislocation or subluxation in the two groups. There were no differences in functional outcomes between the two groups. There was no local recurrence in entire cohort. In the hemiarthroplasty group, one patient was required revision surgery to reverse total shoulder arthroplasty at postoperative 6 years due to rotator cuff dysfunction. In the reverse total shoulder arthroplasty group, one patient showed the fracture occurred at allograft-host bone junction at postoperative 6 months.
Conclusions
Surgical outcomes of hemiarthroplasty with allograft-prosthesis composites were not inferior to reverse total shoulder arthroplasty when applied in properly selected patients. The authors recommended that hemiarthroplasty with allograft-prosthesis composites could be used for young age patients without glenoid metastasis involvement, and reverse total shoulder arthroplasty with allograft-prosthesis composites could be used for patients with old age or metastatic bone tumors.
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Affiliation(s)
- Jian Han
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital , Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Wan Lim Kim
- Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine , Seoul, South Korea
| | - Yongsung Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital , Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital , Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital , Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
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11
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Ellerbrock M, Theil C, Gosheger G, Deventer N, Klingebiel S, Rickert C, Schneider KN. Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma. J Orthop Traumatol 2022; 23:59. [PMID: 36571630 PMCID: PMC9792634 DOI: 10.1186/s10195-022-00678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Improved patient and limb survival rates have led to an increased interest in the functional outcome and return to sports of patients undergoing megaprosthetic reconstruction in musculoskeletal oncology. This study evaluates the functional outcome and postoperatively performed level of sports in patients undergoing proximal humeral replacement (PHR) following resection of a primary bone sarcoma and identifies potential beneficial and limiting factors. PATIENTS AND METHODS Between 2007 and 2020, a total of 606 patients underwent resection of a primary bone sarcoma and reconstruction with a single-design modular implant. For 112 (18%) patients, the location of the tumour was the proximal humerus. Exclusion criteria were death (n = 65), patients living overseas (n = 8), and subsequent amputation (n = 1), leaving 38 patients for evaluation, of whom 32 were available for the study (13 women, median age 42 years). Clinical data regarding oncological and surgical treatment as well as subsequent complications were obtained from the patients' electronic medical records. Functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS) and Toronto Extremity Salvage Score (TESS) as well as the Subjective Shoulder Value (SSV). Return to sports was assessed using the Tegner Activity Score (TS) and the modified Weighted Activity Score (WAS). RESULTS At the last follow-up after a median of 30 months (IQR 22-58), median MSTS was 18 (IQR 12-24), median TESS was 80% (IQR 69-87), median SSV was 35% (IQR 10-58), median TS was 5 (IQR 4-6) and median WAS was 5 (IQR 0-10). Preservation of the axillary nerve, a reverse shoulder reconstruction and a WAS of > 10 prior to surgery were associated with better functional outcome and return to sports activity scores. CONCLUSION Following PHR, good to excellent functional outcomes are possible, and patients regularly return to participate in sports activities-most commonly in low-impact types of sports, but some individuals are even able to participate in high-impact sports activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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12
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Fiore M, Sambri A, Giannini C, Zucchini R, De Cristofaro R, De Paolis M. Anatomical and reverse megaprosthesis in proximal humerus reconstructions after oncologic resections: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:2459-2469. [PMID: 33721053 DOI: 10.1007/s00402-021-03857-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
AIM Anatomic (AN) Endoprosthesis (EPR) reconstructions of the shoulder after intra-articular proximal humerus (Malawer type 1) resections are characterized by early recovery and low complications rate. However, shoulder instability and limited mobility can occur. Reverse shoulder (RS) EPR has been introduced to improve functional outcome. The aim of this systematic review is to evaluate shoulder reconstructions with AN or RS EPR after Malawer type 1 resection, comparing complications and functional results. METHODS Through an electronic systematic search of PubMed, articles concerning EPR after shoulder Malawer type 1 resections were reviewed. Complications rate, range of motion (ROM) and functional outcome (Musculoskeletal Society Tumor Society-MSTS score) of AN and RS EPR were evaluated. RESULTS Sixteen studies were included. A similar complication rate was observed between AN and RS EPR rate (26.4% and 22.4%, respectively, p = 0.37). Soft tissue failure was the most frequent complication and cause of revision in both groups. Mean post-operative flexion and abduction ROM and MSTS scores were significantly higher in RS EPR, particularly among patients with preserved deltoid function (p = 0.013, p = 0.025 and p = 0.005, respectively). CONCLUSIONS Anatomic and reverse shoulder EPR represent safe and effective implants for shoulder reconstruction, with similar implant stability and complication rates. RS EPR significantly improves post-operative ROM and functional outcomes, especially when at least a partial function of the abductor apparatus is preserved.
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Affiliation(s)
- Michele Fiore
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy. .,IRCCS Policlinico di Sant'Orsola, Bologna, Italy.
| | - Claudio Giannini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Riccardo Zucchini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
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Wang S, Luo Y, Wang Y, Zhang Y, Gong T, Tu C, Zhou Y. Early functional and therapeutic effect of reversed tumour shoulder prosthesis reconstruction after proximal humerus tumour resection. Front Surg 2022; 9:987161. [PMID: 36211281 PMCID: PMC9537544 DOI: 10.3389/fsurg.2022.987161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionReconstruction of proximal humeral tumours after resection is still controversial. And there are few articles describing oncology patients' postoperative function after reversed tumour shoulder prosthesis reconstruction. We investigated the functional results of patients who underwent reversed tumour shoulder prosthesis, including those who did not preserve the deltoid ending point.Patients and methodsWe retrospectively evaluated 16 patients with proximal humerus tumours who had undergone reversed tumour shoulder prosthesis. All patients underwent type Malawer I proximal humeral resection surgery and standard reverse tumour shoulder arthroplasty with a modular reverse shoulder prosthesis. We sutured the severed end of the deltoid to the brachialis muscle using the artificial patch for patients who had their deltoid ending point resected. Patients are rehabilitated and followed up according to our instructions.ResultAll patients were followed up for a mean of 27.4 months (13–59), and their mean age was 45.9 years (15–74). The mean length of the humeral resection was 11.6 cm (5–15). The mean shoulder mobility was 122° (82°–180°) in forward flexion; 39° (31°–45°) in posterior extension; 102° (65°–172°) in abduction; 43° (30°–60°) in external rotation; 83° (61°–90°) in internal rotation, and a mean MSTS score of 77.9% (63.3%–93.3%). The mean DASH score was 20.8 (2.5–35.8). The mean VAS score was 0.9. For patients who had their deltoid ending point resected, the mean length of the humeral resection was 14.0 cm; the mean shoulder mobility was 109° in forward flexion; 37.8° in posterior extension; 102.0° in abduction; 38.3° in external rotation; 86.3° in internal rotation, and the mean MSTS score was 78.8%; the mean DASH score was 21.6; the mean VAS score was 1.0.ConclusionPatients who underwent reverse tumour shoulder arthroplasty can achieve good early postoperative function, survival rate and low complication rate. In addition, patients who had their deltoid ending point removed also obtained good function after particular reconstruction.
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Affiliation(s)
| | | | | | | | | | | | - Yong Zhou
- Correspondence: Chongqi Tu Yong Zhou
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14
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Liang H, Guo W, Yang Y, Li D, Yang R, Tang X, Yan T. Efficacy and safety of a 3D-printed arthrodesis prosthesis for reconstruction after resection of the proximal humerus: preliminary outcomes with a minimum 2-year follow-up. BMC Musculoskelet Disord 2022; 23:635. [PMID: 35787280 PMCID: PMC9251937 DOI: 10.1186/s12891-022-05581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the feasibility of using a three-dimensional (3D)-printed arthrodesis prosthesis for reconstruction of the proximal humeral defect after tumor resection. Methods A novel proximal humeral prosthesis was designed to restore bone continuity and shoulder arthrodesis and was fabricated via 3D printing technology. Ten patients with primary malignancies in the proximal humerus underwent intra-articular resection and replacement with this prosthesis from 2017 to 2019. Baseline and operative data, oncological and prosthetic survival, and functional status were summarized. Results This cohort consisted of 9 males and 1 female with a mean age of 32.1 ± 16.1 years. Diagnoses included 5 cases of osteosarcoma, 3 cases of chondrosarcoma and 1 each case of undifferentiated pleomorphic sarcoma and malignant myoepithelioma. The mean operative duration, intraoperative hemorrhage and postoperative length of hospitalization were 151.5 ± 61.0 min, 410.0 ± 353.4 ml and 5.3 ± 1.9 d, respectively. The mean follow-up duration was 29.3 ± 6.4 months, with a minimum of 24 months for the surviving patients. Two patients experienced local recurrence, and four patients developed distant metastases. Detachment of the taper occurred in two patients. One was managed conservatively, and the other received amputation due to concurrent tumor recurrence. The mean MSTS-93 and ASES scores and ranges of forwards flexion and abduction were 24.9 ± 3.1, 79.4 ± 8.3, 71.3 ± 19.4°, and 61.3 ± 16.4°, respectively. The functional outcomes were independent of the preservation of the axillary nerve. Histological study of the glenoid component showed evidence of bone ingrowth at the bone-prosthesis porous interface. Conclusion Application of the 3D-printed arthrodesis prosthesis might be a safe and efficacious method for functional reconstruction in patients who underwent resection of the proximal humerus, especially for those without preservation of the axillary nerve. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05581-6.
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Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.
| | - Yi Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Dasen Li
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
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15
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Callamand G, Barret H, Saint-Genez F, Bonnevialle P, Mansat P, Bonnevialle N. Reconstruction by allograft-prosthetic composite reverse shoulder arthroplasty after proximal humerus tumor resection: Clinical and radiographic assessment at a minimum 2years' follow-up. Orthop Traumatol Surg Res 2022; 108:102957. [PMID: 33962047 DOI: 10.1016/j.otsr.2021.102957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is an option to conserve limb function after resection of proximal humerus malignancy. An allograft-composite RSA is an alternative to a tumor prosthesis, and can restore proximal humeral bone stock. The aim of the present study was to assess medium-term radiographic and clinical results for such composite implants. METHODS Patients with malignant proximal humerus tumor treated by resection and reconstruction by composite RSA were retrospectively analyzed at a minimum 24months' follow-up. Clinical assessment used Constant score, Subjective Shoulder Value (SSV) and ADLER score. Standard radiographic work-up assessed allograft absorption and screened for implant loosening. RESULTS Eleven patients were included, with a mean age of 51years (range: 19-87years) and mean 30months' follow-up (range: 24-84months). Mean tumor resection was 10cm (range: 6-17cm). Etiologies comprised chondrosarcoma (n=6), osteosarcoma (n=2), B-cell lymphoma (n=1) and single metastasis (n=2). Bony increased-offset allograft was associated to humerus reconstruction in 8 cases, and latissimus dorsi tendon transfer in 5 cases. Mean Constant score was 49 points, SSV 52%, and ADLER score 20 points. Increased glenoid implant offset associated to tendon transfer significantly improved anterior elevation and external rotation. Radiographic allograft consolidation to the native humerus was acquired in 73% of cases, while osteolysis in the epiphyseal-metaphyseal zone was found in 64%. There were no cases of humeral implant loosening. Glenoid allograft absorption was systematic (8/8 cases), without inducing loosening of the implant baseplate. CONCLUSION Composite reverse shoulder arthroplasty is functionally effective after massive resection. However, allograft absorption is a drawback, casting doubt on continued use on the glenoid side. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gabriel Callamand
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France.
| | - Hugo Barret
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Florian Saint-Genez
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Paul Bonnevialle
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Pierre Mansat
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Nicolas Bonnevialle
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
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Imam MA, Neumann J, Siebert W, Mai S, Verborgt O, Eckers F, Jacobs L, Meyer DC. Prospective multicentre mid-term clinical and radiological outcomes of 159 reverse total shoulder replacements and assessment of the influence of post-operative complications. Shoulder Elbow 2022; 14:169-180. [PMID: 35265183 PMCID: PMC8899321 DOI: 10.1177/1758573220977184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of our prospective multicentre study is to evaluate the five-year follow-up outcomes of primary reverse shoulder replacement utilizing two different designs of glenoid baseplates. METHODS There were 159 reverse shoulder replacements (91 cemented and 68 uncemented stems, 67 Trabecular Metal baseplates and 92 Anatomical Shoulder baseplates in 152 patients (99 women) with a mean age of 74.5 (58-90) years. The principal diagnosis was rotator cuff arthropathy in 108 shoulders. RESULTS Clinical and functional results improved significantly overall; the adjusted Constant Murley score improved from 28.2 ± 13.3 pre-operatively to 75.5 ± 22.8 (p < 0.0001) and the mean Subjective Shoulder Value improved from 27.5 ± 20 to 73.8 ± 21.3 points (p < 0.0001). Radiologically, there was good bony stability in 88% and 86% of cemented and uncemented stems without significant impact on the Constant Murley score and Subjective Shoulder Value at one, two and five years post-surgery. There were no significant clinical differences between Trabecular Metal and Anatomical Shoulder baseplates at five years. There were four cases of intraoperative shaft fractures that were managed with cables. Although the Trabecular Metal baseplates showed better integration radiologically, there was no significant difference in the mean of Constant Murley, Subjective Shoulder Value and the range of motion depending on the grade of inferior scapular notching at one-, two- and five-year intervals. CONCLUSIONS Reverse total shoulder arthroplasty restores the function in shoulder with significant improvements in function and moderate complications with minor differences between both designs of baseplates that were not reflected clinically.
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Affiliation(s)
- Mohamed A Imam
- Shoulder and Elbow unit, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital, Ashford, UK,Norwich Medical School, University of East Anglia, Norwich, UK,Mohamed A Imam, Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Jörg Neumann
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg GmbH, Hamburg, Germany
| | - Werner Siebert
- Department of Orthopaedic Surgery, Vitos Orthopädische Klinik Kassel GmbH, Kassel, Germany
| | - Sabine Mai
- Department of Orthopaedic Surgery, Vitos Orthopädische Klinik Kassel GmbH, Kassel, Germany
| | - Olivier Verborgt
- Department of Orthopaedic Surgery, AZ Monica Hospital and University Hospital of Antwerp, Antwerpen, Belgium
| | - Franziska Eckers
- Shoulder and Elbow unit, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Leo Jacobs
- Department of Orthopaedic Surgery, Royal Oldham Hospital, Oldham, UK
| | - Dominik C Meyer
- Shoulder and Elbow unit, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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17
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Nguyen Huu M, Trung Tran D, Vu Duc V, Tran Q, Dang QM, Tran TD, Tran Nguyen SQ, Van Tran C. Reverse shoulder megaprosthesis replacement for aggressive aneurysm bone cyst of proximal humerus: Case report and literature review. Ann Med Surg (Lond) 2022; 74:103263. [PMID: 35111306 PMCID: PMC8790613 DOI: 10.1016/j.amsu.2022.103263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION and importance: Wide resection in the surgical treatment of aneurysms bone cysts is often performed in cases where the tumor is large, recurrent, growing, and intensely invasive. Reshaping the defect after tumor removal is a necessary issue to restore shape and maintain function for the patient. CASE PRESENTATION A 26-year-old male patient, diagnosed with an aneurysm bone cyst in the proximal humerus, underwent surgery for curettage and bone grafting twice. After surgery, there was still pain in the shoulder area, the tumor progressed aggressively with limited shoulder movement. Based on the imaging re-evaluation, it was shown that the tumor increased rapidly in size, invaded the soft tissue, and completely changed the normal structure of the shoulder joint, and the proximal humerus. We used a reverse shoulder joint with an additional module to restore the bone defect of the tumor and the function of the shoulder joint. Follows-up showed that patient no longer pain in shoulder area, shoulder joint function recovery is progressing well, Musculoskeletal Tumor Society (MSTS) score is 25 & 28, shoulder joint function score according to ASES scale: 80 & 93.33 respectively at 3 months and 6 months after surgery. CLINICAL DISCUSSION Aggresive aneurysm bone cyst of proximal humerus is not common and still a challenge to the treatment. Due to the bone and joint destruction, the indication of tumor resection and reconstruct the joint and bone loss is required. Among several solution, reverse shoulder megaprosthesis is a newest one can favor the purpose of our treatment. Up to now, this solution is mainly used to preserving for malignant bone tumor. CONCLUSIONS Tumor wide resection with modular reverse shoulder replacement with the modular segment is a reasonable intervention option in cases of large aneurysm bone cysts, with rapid recurrence, aggressive progression, and soft tissue invasion.
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Affiliation(s)
- Manh Nguyen Huu
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Dung Trung Tran
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Viet Vu Duc
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Quyet Tran
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Quang Minh Dang
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Thanh Duc Tran
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Sang Quang Tran Nguyen
- Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
| | - Cong Van Tran
- Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam
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18
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Mengers SRP, Knapik DM, Strony J, Nelson G, Faxon E, Renko N, Getty P, Gillespie R. The Use of Tumor Prostheses for Primary or Revision Reverse Total Shoulder Arthroplasty With Proximal Humeral Bone Loss. J Shoulder Elb Arthroplast 2022; 6:24715492211063108. [PMID: 35669621 PMCID: PMC9163720 DOI: 10.1177/24715492211063108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS (P = .03) and ASES score (P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.
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Affiliation(s)
- Sunita RP Mengers
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - John Strony
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Grant Nelson
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Evan Faxon
- The College of Wooster, Wooster, OH, USA
| | - Nellie Renko
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Patrick Getty
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gillespie
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
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Rajasekaran RB, Ashford R, Stevenson JD, Pollock R, Rankin KS, Patton JT, Gupta S, Cosker TDA. Reconstruction after resection of a proximal humeral tumour : what challenges remain? Bone Joint J 2022; 104-B:3-5. [PMID: 34969269 DOI: 10.1302/0301-620x.104b1.bjj-2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raja B Rajasekaran
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Robert Ashford
- East Midlands Sarcoma Service, Nottingham University Hospitals, Nottingham, UK
| | | | - Rob Pollock
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Kenneth S Rankin
- North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals, Newcastle upon Tyne, UK
| | | | - Sanjay Gupta
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Thomas D A Cosker
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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20
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Ferlauto HR, Wickman JR, Lazarides AL, Hendren S, Visgauss JD, Brigman BE, Anakwenze OA, Klifto CS, Eward WC. Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review. J Shoulder Elbow Surg 2021; 30:e647-e658. [PMID: 34273534 DOI: 10.1016/j.jse.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND In recent years, there has been growing interest in the use of reverse total shoulder arthroplasty (rTSA) for reconstruction of the proximal humerus after oncologic resection. However, the indications and outcomes of oncologic rTSA remain unclear. METHODS We conducted a systematic review to identify studies that reported outcomes of patients who underwent rTSA for oncologic reconstruction of the proximal humerus. Extracted data included demographic characteristics, indications, operative techniques, outcomes, and complications. Weighted means were calculated according to sample size. RESULTS Twelve studies were included, containing 194 patients who underwent rTSA for oncologic reconstruction of the proximal humerus. The mean patient age was 48 years, and 52% of patients were male. Primary malignancies were present in 55% of patients; metastatic disease, 30%; and benign tumors, 9%. The mean humeral resection length was 12 cm. The mean postoperative Musculoskeletal Tumor Society score was 78%; Constant score, 60; and Toronto Extremity Salvage Score, 77%. The mean complication rate was 28%, with shoulder instability accounting for 63% of complications. Revisions were performed in 16% of patients, and the mean implant survival rate was 89% at a mean follow-up across studies of 53 months. CONCLUSIONS Although the existing literature is of poor study quality, with a high level of heterogeneity and risk of bias, rTSA appears to be a suitable option in appropriately selected patients undergoing oncologic resection and reconstruction of the proximal humerus. The most common complication is instability. Higher-quality evidence is needed to help guide decision making on appropriate implant utilization for patients undergoing oncologic resection of the proximal humerus.
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Affiliation(s)
- Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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21
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Management of Humeral and Glenoid Bone Defects in Reverse Shoulder Arthroplasty. J Am Acad Orthop Surg 2021; 29:e846-e859. [PMID: 34192726 DOI: 10.5435/jaaos-d-20-00964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/18/2021] [Indexed: 02/01/2023] Open
Abstract
Bone loss of either the glenoid or the humerus is a challenging problem in reverse total shoulder arthroplasty. When left unaddressed, it can lead to early failure of the implant and poor outcomes. Humeral bone loss can be addressed with the use of an endoprosthesis or allograft prosthetic implant. Glenoid bone loss can be treated with a variety of grafting options, such as augmented implants, patient-specific navigation, and implantation systems.
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22
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Zuo D, Mu H, Yang Q, Sun M, Shen J, Wang H, Ma X, Wang C, Li C, Sun W, Cai Z. Do reverse total shoulder replacements have better clinical and functional outcomes than hemiarthroplasty for patients undergoing proximal humeral tumor resection using devitalized autograft composite reconstruction: a case-control study. J Orthop Surg Res 2021; 16:453. [PMID: 34261497 PMCID: PMC8278672 DOI: 10.1186/s13018-021-02488-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 01/16/2023] Open
Abstract
Objective To compare the efficacy and prognosis of reverse total shoulder arthroplasty (rTSA) with shoulder hemiarthroplasty (SHA) using devitalized autograft or allograft composite reconstruction after proximal humeral tumor resection. Methods We retrospectively reviewed patients who underwent SHA (32) and rTSA (20) for tumor resections of the proximal humerus from January 2014 to July 2020. The clinical results included duration of the operation, intraoperative blood loss, bone union, visual analog scale (VAS) score, shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) shoulder score, recurrence, and overall survival. Results Fifty-two patients were followed up for a mean of 30 months. Thirty-two patients were SHA with allograft-prosthetic composite (APC) reconstructions, while other 20 were rTSA with devitalized autograft-prosthetic composite reconstructions. At the end of the follow-up, 2 recurrence, 3 postoperative infections, and 4 subluxations occurred among the SHA patients. Two patients in the rTSA group had postoperative anterior dislocation and underwent revision surgery with surgical mesh, and 2 (2/20) had grade II scapular notching. The mean VAS score of the shoulder was 1.5 ± 0.8 in the rTSA group and 2.3 ± 1.2 in the SHA group (p < 0.05). The mean active forward flexion of the shoulder joint was 50.6 ± 6.0 in the SHA group and 100 ± 7.6 in the rTSA group (p < 0.05). The ASES shoulder score was 78 ± 3.0 in the rTSA group and 52 ± 5.6 in the SHA group (p < 0.05). The overall 3-year survival rate of all patients was 60.0%, and patients in the rTSA group showed better survival in terms of the mean 3-year OS than patients in the SHA group (p = 0.04). Conclusion rTSA with devitalized autograft-prosthetic composite can offer a reasonable reconstruction of the shoulder joint after Malawer type I tumor resection. Compared with patients who underwent SHA, patients who underwent rTSA present good outcomes, a better range of motion, better bone union, and no increase in instability rate in the mid-term.
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Affiliation(s)
- Dongqing Zuo
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Haoran Mu
- Shanghai Bone Tumor Institute, Shanghai, China
| | - Qingbo Yang
- Department of Thoracic Surgery, Shanghai Tenth People's Hospital affiliated with Tongji University, 301 Yanchang Road, Shanghai, China
| | - Mengxiong Sun
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Jiakang Shen
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Hongsheng Wang
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Xiaojun Ma
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Chongren Wang
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Chuanping Li
- Department of Thoracic Surgery, Shanghai Tenth People's Hospital affiliated with Tongji University, 301 Yanchang Road, Shanghai, China.,Department of Rehabilitation, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Shanghai, China
| | - Wei Sun
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China.
| | - Zhengdong Cai
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated with Shanghai Jiaotong University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Benavente S, Villagra J, Valenti P. Reverse Allograft-Prosthesis Composite with Pectoralis Major Transfer After Shoulder Osteosarcoma: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00025. [PMID: 33599468 DOI: 10.2106/jbjs.cc.20.00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE REPORT We present a case of a 30-year-old man with proximal humerus osteosarcoma and periarticular soft-tissue involvement. Severe humeral and glenoid bone loss was observed, with nonfunctional deltoid after limb-sparing resection and a failed attempt of stabilization. The shoulder was reconstructed using a reverse allograft-prosthesis composite, with deltoid reconstruction by pectoralis major transfer. CONCLUSIONS To the best of our knowledge, this is the first time that this reconstruction technique has been reported in an oncological patient. Favorable clinical and radiological results were achieved at the 24-month follow-up.
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Affiliation(s)
- Sergio Benavente
- Shoulder Unit, Clinique Bizet, Paris, France
- Universidad Católica de la Santísima Concepción, Chile
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Management of Metastatic Disease of the Upper Extremity. J Am Acad Orthop Surg 2021; 29:e116-e125. [PMID: 33492015 DOI: 10.5435/jaaos-d-20-00819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023] Open
Abstract
Metastatic disease is the most common pathologic cause of bone destruction, and the upper extremity is frequently involved. This location presents many surgical challenges, but there have been several recent implant and technique-related advances that have improved outcomes. Patients can be treated nonsurgically, with radiation or with surgery, depending on patient characteristics, signs/symptoms, primary diagnosis, location, and extent of bone destruction. Most locations in the upper extremity besides the humerus can be treated nonsurgically or with radiation. This is also true of the humerus, but when surgery is indicated, plate fixation is acceptable when adequate proximal and distal cortical bone is present for screw purchase. Intramedullary nailing is used frequently in metastatic humeral disease as well, especially in the diaphysis. When extensive destruction or disease progression precludes internal fixation, a resection with endoprosthetic reconstruction can be considered. Oncologic hemiarthroplasty endoprosthetics still have a role, but reverse shoulder designs are beginning to show improved function. Humeral prosthesis designs are continuing to improve, and are becoming more modular, with custom implants still playing a role in certain challenging scenarios.
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26
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Lang NW, Kasparek MF, Synak L, Waldstein W, Funovics PT, Windhager R, Hobusch GM. What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction following primary bone sarcoma resection? Wien Klin Wochenschr 2020; 133:14-20. [PMID: 33296025 PMCID: PMC7840635 DOI: 10.1007/s00508-020-01779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Background The aim of the study was to assess (1) sports activity, (2) sports involving the upper extremities, (3) functional outcome and (4) sports-related complications of long-term survivors of primary malignant bone tumors of the proximal humerus. Methods A total of 18 patients with an endoprosthetic reconstruction for primary malignant bone sarcoma of the proximal humerus (8 male, 10 female, mean age 19.9 ± 8.4 years, range 7.8–37.4 years) with an average follow-up of 18.1 ± 7.4 years (range 6.7–29.8 years) were included. The type of sport, frequency, duration of each sport session and the University of California, Los Angeles (UCLA) activity score were assessed before surgery, at 1 year, 3 years and at the latest follow-up. Functional outcome was assessed by the Toronto extremity salvage score (TESS). Results The mean UCLA activity score decreased from 8.0 (±1.3, range 5–9) preoperative to 4.2 (±1.7, range 3–8) at 1‑year follow-up (p < 0.05). After 3 years it increased to 5.1 (±1.75, range 3–8) and further to 7 (±1.8, range 4–9) at the last follow-up. The mean postoperative TESS was 80.8 (±6.4, range 75.7–91.4) at the latest follow-up. Patients who were initially more active without reconstruction including a synthetic mesh were more likely to develop soft tissue complications accompanied by proximal endoprothesis migration. Conclusion Patients with a modular endoprosthetic reconstruction of the humerus following primary bone sarcoma resume participation in sports. Regarding the low incidence of periprosthetic infections, utilization of a synthetic mesh for reconstruction to prevent soft tissue complications in active patients should be considered.
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Affiliation(s)
- Nikolaus W Lang
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Maximilian F Kasparek
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Lukas Synak
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Philipp T Funovics
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria.
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Boileau P, Raynier JL, Chelli M, Gonzalez JF, Galvin JW. Reverse shoulder-allograft prosthesis composite, with or without tendon transfer, for the treatment of severe proximal humeral bone loss. J Shoulder Elbow Surg 2020; 29:e401-e415. [PMID: 32713667 DOI: 10.1016/j.jse.2020.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer. METHODS An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reverse stem and a "mirror step-cut osteotomy," without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L'Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years). RESULTS Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045). CONCLUSIONS (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L'Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reverse stem with mirror step-cut osteotomy provides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.
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Affiliation(s)
- Pascal Boileau
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France.
| | - Jean-Luc Raynier
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | - Mikaël Chelli
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | | | - Joseph W Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Proximal Humerus Tumors: Higher-than-Expected Risk of Revision With Constrained Reverse Shoulder Arthroplasty. Clin Orthop Relat Res 2020; 478:2585-2595. [PMID: 32281773 PMCID: PMC7571930 DOI: 10.1097/corr.0000000000001245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of proximal humerus tumors with endoprostheses is associated with a high risk of implant-related surgical complications. Because of extensive soft-tissue resection and muscular detachment during surgery, instability is the most common serious complication. A reverse total shoulder arthroplasty with a highly constrained design is one option to mitigate instability, but few studies have reported the results of this prosthesis for proximal humerus tumor resections. QUESTIONS/PURPOSES (1) What are the short-term functional results of the constrained reverse total shoulder prosthesis in terms of Musculoskeletal Tumor Society (MSTS), DASH, and Constant-Murley scores and ROM values? (2) What is the frequency of revision, using a competing-risks estimator to assess implant survival, and what were the causes of the revisions that occurred? (3) What proportion of patients experienced dislocations at short-term follow-up? METHODS Between January 2014 and June 2017, we treated 55 patients with proximal humeral resections and reconstructions for malignant tumors. Of those, 33% (18) of patients were treated with the constrained, reverse total shoulder arthroplasty implant under study here. During that period, no other constrained reverse total shoulder implant was used; however, 13% (seven) of patients were treated with conventional (unconstrained) reverse total shoulder implants, 27% (15) had hemiarthroplasties, 15% (eight) of patients had biologic reconstructions with auto- or allografts and 13% (seven) underwent amputation. During the period in question, our general indications for use of the constrained device under study here were resection of the deltoid muscle/axillary nerve or the deltoid insertion on the humerus due to tumor invasion, or extensive rotator cuff and surrounding soft tissue resection that might result in shoulder instability. During this period, these indications were adhered to consistently. Four of 18 patients treated with the study implant died (three died with the implant intact) and none were lost to follow-up before 2 years, leaving 14 patients (seven women and seven men) for study at a median (range) follow-up of 35 months (25 to 65). Two authors evaluated the clinical and functional status of each patient with ROM (flexion, extension, internal and external rotation, abduction, and adduction) and MSTS, (range 0% to 100%), Constant-Murley (range 0% to 100%), and DASH (range 0 points to 100 points) scores. For the MSTS and Constant-Murley scores, higher percentage scores mean better functional outcome; and for the DASH score, a higher score means more severe disability. Radiographs were obtained at each visit and were used to look for signs of loosening, which we defined as progressive radiolucencies between visits, prosthetic component migration, and fragmentation/fracture of the cement. The Sirveaux classification was used to determine scapular notching. A competing risks analysis with 95% confidence intervals was performed to estimate the cumulative incidence of revision surgery, which we defined as any reoperation in which the implant was removed or changed for any reason, with patient mortality as a competing event. RESULTS At the most recent follow-up, the median (range) MSTS score was 78% (50 to 90), the DASH score was 20 (8 to 65), and the Constant-Murley score was 53% (26 to 83). The median ROM was 75° in forward flexion (40 to 160), 78° in abduction (30 to 150), 35° in internal rotation (10 to 80), and 33° in external rotation (0 to 55). Postoperatively, two of 14 patients underwent or were supposed to undergo revision surgery, and the cumulative incidence of revision surgery was 18% for both 30 and 48 months (95% CI 2 to 45). During the study period, no patients reported instability, and no dislocations occurred. CONCLUSIONS Our findings are concerning because the revision risk with this constrained reverse total shoulder implant was higher than has been reported by others for other proximal humerus prostheses. The highly constrained design that helps prevent instability might also transmit increased stresses to the humeral component-bone interface, therefore making it susceptible to loosening. We believe that any other implant with a similar degree of constraint will have the same problem, and changing the indications for patient selection may not solve this issue. These theories need to be tested biomechanically, but our desire is to warn surgeons that while trying to prevent instability, one might trade one complication (instability) for another: aseptic loosening. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Allograft-Composite Reverse Shoulder Arthroplasty for Malignant Tumor of the Proximal Humerus. Tech Hand Up Extrem Surg 2020; 25:94-101. [PMID: 33044287 DOI: 10.1097/bth.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Composite-allograft reverse shoulder arthroplasties are a surgical alternative in malignant tumor reconstructions following segmental bone resection of the proximal humerus. They allow reinsertion of the rotator cuff tendons and reliable restoration of humeral height, increasing prosthetic stability and mobility. Preoperative local tumor extension assessment must be thorough and a strict surgical technique must be followed to obtain satisfactory functional results. The indications for this procedure include a strictly intraosseous tumor of the proximal humerus corresponding to an S3-S4 A resection following criteria provided by the Musculoskeletal Tumor Society as described by Enneking and colleagues in 1990. Certain conditions must question the procedure such as extended S3-S4-S5 bone resections, partial sacrifice of the deltoid muscle, preoperative deltoid impairment, and glenohumeral arthrectomy. Here, we report technical details and indications of composite-allograft reverse shoulder arthroplasty in the context of tumor segmental resection of the proximal humerus, especially in the humeral preparation.
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30
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Preliminary results of reconstruction of proximal humeral bone loss with a reverse total shoulder prosthesis using a modular endoprosthetic reconstruction system: a case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Limb Salvage and Reconstruction Options in Osteosarcoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1257:13-29. [PMID: 32483727 DOI: 10.1007/978-3-030-43032-0_2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in chemotherapy, sophisticated imaging, and surgical techniques over the last few decades have allowed limb-salvage surgery (LSS) to become the preferred surgical treatment for bone sarcomas of the extremities. The goal of LLS is to maximize limb functionality to allow for the maintenance of quality of life without compromising overall survival and tumor local recurrence rates. Today, limb-salvage procedures are performed on 80-95% of patients with extremity osteosarcoma, and the 5-year survival rate in extremity osteosarcoma patients is now 60-75%.This chapter will focus on LSS for extremity osteosarcoma. Common types of surgical reconstruction techniques including endoprostheses, intercalary or osteoarticular allografts, vascularized fibular autografts, and allograft prosthetic composites (APC), and their complications such as infection, local recurrence, graft fracture, implant failure, and nonunion will be discussed in detail. Anatomic locations of lesions discussed include the proximal femur, distal femur, proximal tibia, distal tibia, proximal humerus, distal humerus, and forearm bones.
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Abstract
Proximal humeral bone loss in revision shoulder arthroplasty poses a significant obstacle to achieving stable and reliable fixation of the humeral stem. It is important to identify and classify this bone loss preoperatively, which can range from epiphyseal to substantial diaphyseal bone loss. There are several reconstructive options that can address the varying levels of bone loss, including cemented long-stem fixation, a composite construct using proximal humeral allograft or femoral allograft, proximal humeral endoprosthetic replacement, or total humeral replacement. All of these are viable reconstructive options that have demonstrated adequate to good outcomes.
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Affiliation(s)
- Timothy Kahn
- Department of Orthopaedic Surgery, University of Utah Medical Center, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Medical Center, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Grey B, Rodseth RN, Roche SJ. Humeral Stem Loosening Following Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2019; 6:e5. [PMID: 29762342 DOI: 10.2106/jbjs.rvw.17.00129] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The timing and the factors contributing to aseptic stem loosening remain poorly understood. METHODS We performed a systematic review that identified 75 articles; 65 of the included articles were case series (Level-IV evidence), 8 were cohort studies (7 Level III, 1 Level II), and 2 were prospective randomized controlled trials (Level I). A meta-analysis of 1,660 cemented and 805 uncemented RSA stems was performed. We compared the rates of aseptic stem loosening, humeral radiolucent lines, and revision for stem loosening (1) between cemented and uncemented stems in cohorts with short and long mean follow-up periods (<5 and ≥5 years) as well as in all cohorts combined, and (2) among different etiological subgroups. RESULTS Aseptic stem loosening occurred more commonly in the cohort with long compared with short follow-up time (2% versus 0.8%, p = 0.01). When comparing cemented with uncemented stems, there was no significant difference in the rates of aseptic stem loosening or revision for stem loosening in either the short or long-term follow-up groups. Humeral radiolucent lines were more common with cemented compared with uncemented stems (15.9% versus 9.5%, p = 0.002). Analyzed by etiology, the highest rate of aseptic stem loosening occurred in the tumor subgroup (10.8%), followed by RSA as a revision procedure after a failed arthroplasty (3.7%). No stems in the acute fracture or fracture sequelae subgroups developed aseptic stem loosening. CONCLUSIONS Aseptic stem loosening occurred more commonly in cohorts with longer follow-up. There were no differences in the rates of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Patients treated with RSA following excision of proximal humeral tumors and RSA as a revision procedure after a failed arthroplasty were at greater risk of aseptic stem loosening. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ben Grey
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Reitze N Rodseth
- Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa.,Department of Anaesthetics, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stephen J Roche
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Grosel TW, Plummer DR, Everhart JS, Kirven JC, Ziegler CL, Mayerson JL, Scharschmidt TJ, Barlow JD. Reverse total shoulder arthroplasty provides stability and better function than hemiarthroplasty following resection of proximal humerus tumors. J Shoulder Elbow Surg 2019; 28:2147-2152. [PMID: 31405716 DOI: 10.1016/j.jse.2019.02.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tumors may necessitate resection of a substantial portion of the proximal humerus and surrounding soft tissues, making reconstruction challenging. We evaluated outcomes in patients undergoing treatment of tumors of the proximal humerus with reverse total shoulder arthroplasty (rTSA) or shoulder hemiarthroplasty. METHODS Patients who underwent rTSA (n = 10) or shoulder hemiarthroplasty (n = 37) for tumors of the proximal humerus in 2009 to 2017 were reviewed. Of these patients, 27 had died, leaving 20 for review. The mean follow-up period of the survivors was 27.1 months. They were evaluated clinically and contacted to determine the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and visual analog scale score. RESULTS Postoperative complications occurred in 13 hemiarthroplasty patients (34%). Tumor recurrence occurred in 3 hemiarthroplasty patients (7.9%), whereas in the rTSA group, 1 patient (10%) had a postoperative complication, with no recurrences. One hemiarthroplasty patient required revision surgery with rTSA to improve shoulder function. Six dislocations and two subluxations occurred in the hemiarthroplasty group, whereas no subluxations occurred in the rTSA group (P = .14). Mean range of motion was 85° of forward flexion for rTSA patients (n = 10) compared with 28° for hemiarthroplasty patients (P < .001). The mean American Shoulder and Elbow Surgeons score was 63 for hemiarthroplasty patients (n = 5) and 59 for rTSA patients (n = 4). The mean Simple Shoulder Test scores were 3.8 and 2.4, respectively. The mean visual analog scale pain scores were 2.4 and 2.5, respectively. CONCLUSION Reverse total shoulder arthroplasty can reproducibly reconstruct the shoulder in patients requiring oncologic proximal humerus resection. Patients have good outcomes, better range of motion, and no increase in instability rates compared with hemiarthroplasty.
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Affiliation(s)
- Timothy W Grosel
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Darren R Plummer
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua S Everhart
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James C Kirven
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Chance L Ziegler
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joel L Mayerson
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thomas J Scharschmidt
- Department of Orthopedics, The Ohio State University College of Medicine, Columbus, OH, USA
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What Is the Survival and Function of Modular Reverse Total Shoulder Prostheses in Patients Undergoing Tumor Resections in Whom an Innervated Deltoid Muscle Can Be Preserved? Clin Orthop Relat Res 2019; 477:2495-2507. [PMID: 31389894 PMCID: PMC6903840 DOI: 10.1097/corr.0000000000000899] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After proximal humerus resection for bone tumors, restoring anatomy and shoulder function remains demanding because muscles and bone are removed to obtain tumor-free surgical margins. Current modes of reconstruction such as anatomic modular prostheses, osteoarticular allografts, or allograft-prosthetic composites and arthrodeses are associated with relatively poor shoulder function related to loss of the deltoid and rotator cuff muscles. Newer prosthetic designs like the reverse total shoulder arthroplasty (RTSA) are felt to be useful in other reconstructions where rotator cuff function is compromised, so it seemed logical that it might help in tumor reconstructions as well in patients where the deltoid muscle and its innervation can be preserved. QUESTIONS/PURPOSES In patients with a tumor of the proximal humerus that can be resected with preservation of the deltoid muscle, (1) What complications are associated with tumor resection and reconstruction with a modular RTSA? (2) What are the functional results of modular RTSA in these patients? METHODS From January 2011 to January 2018, we treated 52 patients for bone tumors of the proximal humerus. Of these, three patients were treated with forequarter amputation, 14 were treated with standard modular proximal humerus implants, seven were treated with allograft-prosthetic composites (RTSA-APC), and 28 were treated with a modular RTSA. Generally, we used anatomic modular prosthetic reconstruction if during the tumor resection none of the abductor mechanism could be spared. Conversely, we preferred reconstruction with RTSA if an innervated deltoid muscle could be spared, but the rotator cuff and capsule could not, using RTSA-APC or modular RTSA if humeral osteotomy was distal or proximal to deltoid insertion, respectively. In this study, we retrospectively analyzed only patients treated with modular RTSA after proximal humerus resection. We excluded three patients treated with modular RTSA as revision procedures after mechanical failure of previous biological reconstructions and three patients treated after December 2016 to obtain an expected minimum follow-up of 2 years. There were nine men and 13 women, with a mean (range) age of 55 years (18 to 71). Reconstruction was performed in all patients using silver-coated modular RTSA protheses. Patients were clinically checked according to oncologic protocol. Complications and function were evaluated at final follow-up by the treating surgeon (PR) and shoulder surgeon (AC). Complications were evaluated according to Henderson classification. Functional results were assessed with the Musculoskeletal Tumor Society score (range 0 points to 30 points), Constant-Murley score (range 0 to 100), and American Shoulder and Elbow Surgeons score (range 0 to 100). The statistical analysis was performed using Kaplan-Meier curves. RESULTS Complications occurred in five of 22 patients; there was a shoulder dislocation (Type I) in four patients and aseptic loosening (Type II) in one. Function in these patients on the outcomes scales we used was generally satisfactory; the mean Musculoskeletal Tumor Society score was 29, the mean Constant score was 61, and the mean American Shoulder and Elbow Surgeons score was 81. CONCLUSIONS Although this was a small series of patients with heterogeneous diagnoses and resection types, and we were not able to directly compare the results of this procedure with those of other available reconstructions, we found patients treated with RTSA achieved reasonable shoulder function after resection and reconstruction of a proximal humerus tumor. It may not be valuable in all tumor resections, but in patients in whom the deltoid can be partly spared, this procedure appears to reasonably restore short-term shoulder function. However, future larger studies with longer follow-up are needed to confirm these findings. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Proximal humeral endoprosthesis after tumor resection: does synthetic mesh improve stability? A radiographic review. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sirveaux F. Reconstruction techniques after proximal humerus tumour resection. Orthop Traumatol Surg Res 2019; 105:S153-S164. [PMID: 29958931 DOI: 10.1016/j.otsr.2018.04.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023]
Abstract
Reconstruction of the proximal humerus after tumour resection is a surgical challenge. The goal consists not only in reconstructing the resected bone segment, but also in restoring a stable and mobile shoulder. The choice of the technique depends on the status of the soft-tissues at the end of the resection. The preoperative work-up must determine the oncological goals of the resection and identify the structures that can be spared. When deltoid muscle function is preserved, a reverse prosthesis offers the best stability and mobility outcomes. The objective of this work is to describe the indications and techniques used in the various available reconstruction methods. Shoulder mobilities are restored using some of these methods and lost with others. Emphasis is put on the reverse shoulder prosthesis, with a description of its variants (standard prosthesis, cement sleeve, allograft-prosthesis composite, and massive prosthesis) and a discussion of the management of its early complications. When performing reverse shoulder arthroplasty, glenoid implant preparation and positioning are crucial to achieve stability, and humeral length restoration will govern soft-tissue tension. Latissimus dorsi tendon transfer is required to restore active external rotation if the posterior rotator cuff tendons have been removed. Allograft-anatomic prosthesis composites, osteo-cartilaginous allografts, arthrodesis, and spacer prostheses are proposed for patients in whom the local conditions preclude implantation of a reverse shoulder prosthesis.
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Affiliation(s)
- François Sirveaux
- CHRU, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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Liu Q, Dai Z, Wu J, Ji S, Bai J, Jiang R. Feasibility Analysis and Clinical Applicability of a Modified Type V Resection Method for Malignant Bone Tumors of the Proximal Humerus. J INVEST SURG 2018; 33:191-197. [PMID: 30380348 DOI: 10.1080/08941939.2018.1483445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The purpose of this study was to explore the feasibility and clinical applicability of a modified type V resection method for malignant bone tumors of the proximal humerus. Methods: The relevant anatomic MRI data from 30 normal adult shoulder joints were measured to analyze the feasibility of the modified type V resection method for malignant bone tumors of the proximal humerus. Sixteen patients with malignant bone tumors of the proximal humerus were treated with modified radical resection between March 2012 and April 2017. Recurrence of tumor was evaluated after surgery, and shoulder function was assessed according to the Enneking skeletal muscle tumor function scoring system. Results: Radiographic results showed that the modified type V resection method was feasible, and within the allowable range of the maximum longitudinal diameter (<29.8 mm) and depth (<4 mm). Surgery was successfully completed in all 16 cases, and pathological examination suggested that the purposes for radical resection had been achieved. All patients were followed up over 3-49 months (mean, 15.6 months). One patient had local recurrence at 12 months after surgery, and we performed upper limb amputation. The remaining 15 patients had good prosthesis survival. At the final follow-up, shoulder joint function had recovered compared with preoperative levels, with a mean Enneking score of 25.8 points (range, 24-27 points). Conclusion: Modified type V resection may be feasible for treating tumors of the proximal humerus, maintaining good early shoulder function.
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Affiliation(s)
- Qing Liu
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhibing Dai
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Junshen Wu
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Suzhi Ji
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jingping Bai
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Renbing Jiang
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Limb salvage in the upper limb: a review. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lazerges C, Dagneaux L, Degeorge B, Tardy N, Coulet B, Chammas M. Composite reverse shoulder arthroplasty can provide good function and quality of life in cases of malignant tumour of the proximal humerus. INTERNATIONAL ORTHOPAEDICS 2017. [PMID: 28646420 DOI: 10.1007/s00264-017-3538-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Management of proximal humeral tumours remains a surgical challenge. No study to date has assessed the quality of life scores following the composite reverse shoulder arthroplasty for this indication. We, therefore, evaluated function and quality of life following reconstruction with allograft for malignant tumour of the humerus. METHODS A series of six cases of humeral tumour treated by a single surgeon in a single centre was reviewed after a mean follow-up of 5.9 years. The tumours included two chondrosarcomas, one plasmocytoma and three metastases. Resection involved bone epiphysis, metaphysis and diaphysis in five cases (S3S4S5A) and epiphysis and metaphysis in one case (S3S4A). For reconstruction, an allograft composite reverse shoulder arthroplasty was used in all the cases. Outcomes were assessed with range of motion, the QuickDash score and the Short Form 12 (SF-12) Health Survey. Radiographs assessed osseointegration and complications. RESULTS At the final follow-up, the mean shoulder range of motion were respectively 95°, 57° and 11° for forward flexion, abduction and external rotation. Mean QuickDASH score improved from 28 to 41 and VAS-pain scores improved from 5.1 to 2.3. The post-operative MSTS score was 73% and the Constant score was 46.1/100. The SF-12 PCS and MCS scores were also improved, respectively from 44.4 and 39.7 to 45.5 and 56.1. The mean satisfaction score was 8.1/10. CONCLUSIONS Composite reverse shoulder arthroplasty is a viable alternative for reconstruction after resection of malignant humeral tumour. Although total tumour resection was the most important objective, the functional and quality of life scores were satisfactory.
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Affiliation(s)
- Cyril Lazerges
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital of Montpellier, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France.
| | - Louis Dagneaux
- Hip, Knee and Foot Surgery Unit, Lapeyronie University Hospital of Montpellier, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France
| | - Benjamin Degeorge
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital of Montpellier, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France
| | - Nicolas Tardy
- Centre ostéo articulaire des Cèdres, 21 Rue Albert Londres, 38432, Échirolles, France
| | - Bertrand Coulet
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital of Montpellier, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France
| | - Michel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital of Montpellier, 191 avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France
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