Clinical outcomes following reverse shoulder arthroplasty–allograft composite for revision of failed arthroplasty associated with proximal humeral bone deficiency: 2- to 15-year follow-up

Cox, Jacob L.; McLendon, Paul B.; Christmas, Kaitlyn N.; Simon, Péter; Mighell, Mark A.; Frankle, Mark A.

doi:10.1016/j.jse.2018.10.023

Cited by 39 publications

(20 citation statements)

References 15 publications

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“…Our results agree with those of the few previous cohorts in which the clinical and radiologic outcomes of RS-APC were evaluated. 13,17,34,36,46 One main difference between our series and other series is the severity of humeral bone loss in our cohort: The median length of bone loss was 8 cm (range, 5-23 cm), and 10 of our patients had bone loss 11 cm. Chacon et al 13 reported mean bone loss of 5.4 cm, whereas Cox et al 17 in their cohort found average bone loss of 5.5 cm.…”

Section: Severity Of Humeral Bone Lossmentioning

confidence: 66%

“…13,17,34,36,46 One main difference between our series and other series is the severity of humeral bone loss in our cohort: The median length of bone loss was 8 cm (range, 5-23 cm), and 10 of our patients had bone loss 11 cm. Chacon et al 13 reported mean bone loss of 5.4 cm, whereas Cox et al 17 in their cohort found average bone loss of 5.5 cm. The findings in the series of Sanchez-Sotelo et al 46 are closer to ours, with an average of 7.6 cm and 8.4 cm of bone loss in primary and revision surgical procedures, respectively.…”

Section: Severity Of Humeral Bone Lossmentioning

confidence: 66%

“…Allograft resorption was defined as resorption of the allograft bone >25% on the latest available radiograph. 13,17,18,46 Radiographic evaluation emphasized humeral radiolucent lines according to the Sperling classification, 49 implant migration, periprosthetic fracture, and scapular notching. 38 CT scans were obtained in all patients to assess graft bone healing or graft resorption or lysis.…”

Section: Clinical and Radiologic Analysismentioning

confidence: 99%

“…11,32,33,48 Although reconstruction of the proximal humeral bone stock, together with restoration of a functional glenohumeral joint, is desirable, such a complex surgical procedure is rare and remains a challenge for the shoulder surgeon. 12,13,17,19,34,46 Historically, different reconstructive techniques such as arthrodesis, 15 massive osteoarticular allografts, 24,25,42 and massive anatomic tumor prostheses 1,3,21,30 have been proposed. Because of the good results observed in patients with cuff tear arthritis or massive cuff tears, reverse shoulder arthroplasty (RSA) was introduced as a reconstructive option in patients with proximal humeral resection or bone loss.…”

mentioning

confidence: 99%

“…Because of the good results observed in patients with cuff tear arthritis or massive cuff tears, reverse shoulder arthroplasty (RSA) was introduced as a reconstructive option in patients with proximal humeral resection or bone loss. 9 Basically, modern reconstructive options for PHBL or resection include the use of a mega-tumor reverse prosthesis 11,27,29,33,48,50,54 and RSA without 7,27,29,33,48,50,54 or with allograft augmentation, 13,17,18,34,36,46 so-called reverse shoulder-allograft prosthesis composite (RS-APC).…”

mentioning

confidence: 99%

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Reverse shoulder–allograft prosthesis composite, with or without tendon transfer, for the treatment of severe proximal humeral bone loss

Boileau

Raynier

Chelli

et al. 2020

Journal of Shoulder and Elbow Surgery

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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 ¼ .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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