High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections

Abstract

Introduction The Tikhoff-Linberg procedure is a limb salvage technique for tumours of the shoulder girdle which preserves function of the hand and elbow; however, shoulder function is limited. A humeral cap endoprosthesis (Stryker Orthopedics, Mahwah, NJ, USA) was developed within the Modular Replacement System (MRS) to act as a functional spacer for these defects; however, the outcomes of this implant have not been described. Methods Thirty-three (17 male, 16 female) patients underwent a Tikhoff-Linberg procedure at our institution. Of these, 17 (11 females, 6 males) were reconstructed with a MRS humerus endoprosthesis. Outcomes and complications were compared between patients who were reconstructed (n = 17) and those who were not (n = 16). Results Complications occurred in 14 (42%) patients, with more complications in patients who were reconstructed (n = 11, 65% vs. n = 3, 19%, p = 0.01). Endoprosthetic complications included stress shielding of the bone/prosthesis interface (n = 7, 41%) and subluxation/instability (n = 5, 29%), leading to a revision surgery in two (12%). Post-operatively, the mean Musculoskeletal Tumor Society Score (MSTS93) was 67 ± 11%, with no difference in the mean MSTS93 between patients who were reconstructed and those who were not (67 ± 10% vs. 68 ± 12%, p = 0.77). Conclusions Reconstruction with a MRS humerus cap endoprosthesis resulted in a high rate of complications following a Tikhoff-Linberg procedure. Stress shielding and subluxation were common, and as such, the use of this prosthesis is limited to cases where a standard implant is not a feasible option.

A Retrospective Study of the Functional Outcomes in Patients with Proximal Humeral Bone Defect after Shoulder Fusion or Prosthetic Replacement

“…The lateral elevation and forward flexion ranges in the prosthetic replacement group were lower than those in the shoulder arthrodesis group. No more than 30 • abduction and 45 • forward flexion could be achieved in prosthesis cases in the present study and in most published studies [15][16][17].…”

Reducing the prosthesis modulus by inclusion of an open space lattice improves osteogenic response in a sheep model of extraarticular defect

“…Moreover, the engineered porosity (if substantial) reduces device’s elastic modulus, which has been suggested to result in enhanced osteogenesis and reduced stress shielding of the periprosthetic bone ( Huiskes et al, 1992 ; Sumner and Galante, 1992 ; Nouri and Hodgson, 2010 ; Moghaddam et al, 2016 ; Caffrey et al, 2018 ). Stress shielding is a common complication of endoprosthetic reconstruction surgery and is significant not only because of associated surgical failure, but also due to the resulting periprosthetic osteopenia, which significantly limits future treatment options ( Nagels et al, 2003 ; Tagliero et al, 2020 ; Braig et al, 2021 ; Cho et al, 2021 ; Bendich et al, 2022 ). Selecting an appropriate prosthesis modulus is crucial to achieving the best possible functional and long-term outcomes for patients with medical implants because it ensures that the mechanical properties of the artificial implant closely match those of the surrounding natural tissues and bones, preventing issues like stress shielding and subsequent implant loosening, or implant failure that may arise if the prosthesis is too rigid or too flexible compared to the natural tissue.…”

What is the patient acceptance when only scapulectomy is possible in case of malignant tumor? A case series

“…This is a historical series in a reference center for bone and soft tissue cancers, including exclusively scapulectomies, which explains the small number of patients. On the other hand, this is a homogeneous monocentric study using a single method, namely scapulectomy without reconstruction by prosthesis 20 , 26 , 28 , 29 or by allograft 32 of the scapula. This approach was justified by the fact that each of the patients included in this series required extensive soft tissue resection, most often involving the rotator cuff muscles, deltoid, trapezius, latissimus dorsi, and rhomboids muscle.…”