Allograft prosthetic composite reconstruction using a reverse total shoulder arthroplasty for failed oncologic proximal humerus reconstruction

Abstract

Introduction Endoprosthetic or allograft reconstruction are the preferred reconstruction techniques for proximal humeral bone tumors. Failure of these reconstructions may occur, but historically revision is performed rarely due to the lack of reliable options. Reverse shoulder arthroplasty with an allograft prosthetic composite (rAPC) may provide a revision option. The purpose of the current study was to evaluate our institutional outcome of these procedures. Methods Eleven (6 male, 5 female) patients (mean age 51 ± 17 years) underwent revision of a failed oncologic reconstruction of the proximal humerus utilizing a rAPC. The most common indication for revision was subluxation (n = 6) and the most common previous implant was an endoprosthesis (n = 5). Results Revision resulted in improvements in shoulder elevation (39° vs. 62°, p = 0.02), external rotation (13° vs. 25°, p = 0.04), American Shoulder and Elbow Surgeons score (39 vs. 58, p = 0.004) and Musculoskeletal Tumor Society Scores (51% vs 69%, p = 0.002). There were 2 re‐revision procedures performed. One for an allograft fracture and one for allograft resorption and loosening. Conclusions Revision with a rAPC can effectively restore patient function. Due to the complexity of the cases, we advocate for these procedures to be performed by subspecialty upper extremity surgeons trained in complex revision shoulder arthroplasty.

Allograft-Prosthetic Composite Reconstruction for Proximal Humerus Bone Loss

“…Noncomparative studies had an average score of 12.3 6 0.9 while comparative studies averaged 18.5 6 0.6, indicating moderate quality of evidence. See Supplementary Table for individual studies and MINORS scores 2,6,7,[9][10][11][12][18][19][20][21][22][23][24][25][26] .…”

“…Similarly, APC fracture/fragmentation rates were reported by less than half of the included studies (6 of 16) 2,7,11,21,23,26 . The mean time to APC union was reported even less frequently (4 of 16) 2,6,21,23 . The heterogeneity in the radiographic assessment of APC reconstruction makes cross-study comparison difficult.…”

“…Without a clear definition, it is uncertain whether this lack of healing was substantial enough to compromise the structural integrity of the construct. Similarly, APC fracture/fragmentation rates were reported by less than half of the included studies (6 of 16) 2,7,11,21,23,26 . The mean time to APC union was reported even less frequently (4 of 16) 2,6,21,23 .…”

What’s New in Musculoskeletal Tumor Surgery

“…Re-revisions were required for 2 patients with allograft-related complications. The overall function improved significantly 33 . Finally, Jawad et al queried the SEER database for patients diagnosed with primary sarcomas originating from the bones of the hand and the wrist and reported that disease-specific survival was 90% at 5 years and 84% at 10 years 35 .…”

Proximal Humerus Reconstruction for Bone Sarcomas

“…Secondary to a historic lack of options (and often a lack of pain in these patients), revision of a subluxated or dislocated proximal humeral hemiarthroplasty endoprosthesis was not routinely performed. Recent work, however, has shown that patients can be converted to a reverse total shoulder allograft prosthetic composite (APC), with improvements in shoulder function and a relatively low rate of complications, offering a way to potentially improve functional outcomes in these patients 35 .…”