Is Scapular Endoprosthesis Functionally Superior to Humeral Suspension?

Pritsch, Tamir; Bickels, Jacob; Wu, Chia-Chun; Squires, Malcolm H.; Malawer, Martin M.

doi:10.1097/01.blo.0000238840.26423.b6

Cited by 59 publications

(70 citation statements)

References 16 publications

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“…However, since 1992, the trend has been reconstruction with a scapular prosthesis in order to obtain better functional and cosmetic results. Pritsch et al [9] reported the functional and cosmetic results and concluded that scapular endoprosthetic reconstruction led to better functional (78.5% VS 58.5%) and cosmetic results compared to humeral suspension. In our group, one patient with scapular prosthetic replacement achieved satisfactory functional recovery (77%).…”

Section: Discussionmentioning

confidence: 99%

Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results

Yang

Zhang

et al. 2009

International Orthopaedics (SICOT)

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It is a great challenge to spare the upper limb with a malignant or invasive benign bone tumour of the shoulder girdle. We retrospectively analysed 35 patients with bone tumours of the shoulder girdle treated with various limb salvage procedures. The tumours included 25 primary malignancies, three metastases and seven giant cell tumours which involved the proximal humerus in 21 patients, scapula in 12 and clavicle in two. The reconstruction procedures included eight prosthetic replacements, four devitalised tumorous bone grafts, three osteoarticular allografts, two autogenous fibular grafts, one intramedullary cemented nail, three Tikhoff-Linberg procedures, two replantation of shortened arms, and four humeral head suspensions. Six partial scapulectomies and two lateral clavicectomies needed no bone reconstruction. With an average follow-up of 71 months, local recurrences occurred in four cases and systemic metastases in six. Nine patients died and 23 remained disease free. The five year Kaplan-Meier survival rate of 28 patients with malignancies was 69.5%. The average Musculoskeletal Tumour Society (MSTS) functional score was 77% (range 40-100%) in all patients.

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Section: Discussionmentioning

confidence: 99%

Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results

Yang

Zhang

et al. 2009

International Orthopaedics (SICOT)

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“…However, the trend has been reconstruction with a scapular prosthesis in order to obtain better functional and cosmetic results. Every method has its advantages and disadvantages so that there is no optimal reconstructive strategy [9] [14] [16]. For the preservation of shoulder function after total scapulectomy, not only soft tissue reconstruction but also bony reconstruction is theoretically preferable.…”

Section: Discussionmentioning

confidence: 99%

“…For the preservation of shoulder function after total scapulectomy, not only soft tissue reconstruction but also bony reconstruction is theoretically preferable. Prosthetic reconstruction is the most common procedure in bone tumor surgery, but the availability of scapular prosthesis is much lower, which directly relates to functional recovery [16]. The use of osteoarticular allograft in oncology surgery is well known with good functional outcome [17].…”

Section: Discussionmentioning

confidence: 99%

Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

Traoré¹,

Tribak²,

Doukouré³

et al. 2015

OJO

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Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary A. Traoré et al. 391 nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

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“…For high grade sarcomas, a wide margin is considered adequate and will achieve successful control of the primary tumor approximately 95% of the time, whereas marginal or intralesional margins are associated with higher rate of local recurrence and poor outcomes 26 . For bone 3cm away from the extent on T1-MRI image is adequate [27][28][29][30][31][32] . The marrow is always sent from the cut end for frozen section evaluation for tumour.…”

Section: Surgical Resections and Reconstructionsmentioning

confidence: 99%

“…Scapular endoprosthesis after a scapulectomy may provide better function than simple humeral suspension of the latissimus dorsi, trapezius, deltoid and rhomboids can be preserved with better abduction and flexion. 31 It is now possible to reconstruct the entire humerus or femur (fig 4)with prosthesis. Though the surgery involves a massive exposure and long duration, the functional results have been superior to that after an amputation and external prosthesis.…”

Section: Megaprosthesismentioning

confidence: 99%