Large diaphyseal-incorporating allograft prosthetic composites: when, how, and why

McLendon, Paul B.; Cox, Jacob L.; Frankle, Mark A.

doi:10.1007/s00132-017-3498-z

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…Reverse APCs' have been utilized in the revision total shoulder setting with favorable outcomes in the setting of massive proximal humerus bone loss, however their use in the revision of a failed oncologic prosthesis is limited. 15,27,33,34 In the series by Sanchez-Sotelo et al 15 and Boileau et al 33 the series include patients undergoing a revision to a reverse APC due to a failed tumor prosthesis, however the results of these patients are not elucidated as a separate group.…”

Section: Discussionmentioning

confidence: 99%

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

Houdek

Wagner

Rose

et al. 2021

Journal of Surgical Oncology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Houdek

Wagner

Rose

et al. 2021

Journal of Surgical Oncology

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“…The first technique advocates a flatcut osteotomy and fixation of the humeral allograft with a lateral metallic plate to maximize compression and bony union. [34][35][36]45,46 The second technique, promoted by Frankle and colleagues, 13,17,18,39,40 advocates a step-cut osteotomy of the bone graft so that approximately 5 cm of bone remains laterally, resulting in a lateral bony plate, which allows fixation of the allograft to the native bone with metallic cerclage wires or cables. Our technique is slightly different because we do not use a metallic or bony plate to fix the graft to the native bone.…”

Section: Graft Union and Survivalmentioning

confidence: 99%

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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“…Significant heterogeneity exists regarding the severity of bone loss encountered during surgery. There are factors that may predispose patients to more advanced bone loss, resulting in the use of larger allografts, longer stems, and additional modes of fixation [ 15 , 16 ]. Management of severe proximal humeral bone loss thus remains a surgical challenge.…”

Section: Introductionmentioning

confidence: 99%

Allograft Prosthesis Composite (APC) for Proximal Humeral Bone Loss: Outcomes and Perspectives

Gregori,

Perricone,

Franceschetti

et al. 2023

JPM

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(1) Background: Allograft prosthetic composite (APC) represents one of the techniques used for reconstruction in large proximal humeral bone deficits. The present systematic review aimed at summarizing the state of the art of the technique and analyzing its outcomes. (2) Methods: The PRISMA guidelines were followed to perform this systematic review. A systematic electronic search was performed using PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. All the studies analyzing the rates of allograft prosthesis composite were pooled, and the data were extracted and analyzed. (3) Results: A total of 10 studies were eligible for inclusion in this systematic review for a total of 239 patients. The rate of patient satisfaction with surgery was reported in 7 studies with a mean of 86.4% ± 13.64. The mean constant score was 45.7 ± 3.51, the mean ASES score was 63.58 ± 8.37, and the mean SST was 4.6 ± 1.04. The mean revision rate observed was 10.32% ± 3.63 and the mean implant survival was 83.66% ± 14.98. (4) Conclusions: Based on the currently available data, allograft prosthesis composite represents a valuable option for the reconstruction of proximal humeral deficits. All studies analyzed showed the favorable impact of this surgical technique on clinical outcomes and patient satisfaction.

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Large diaphyseal-incorporating allograft prosthetic composites: when, how, and why

Cited by 8 publications

References 16 publications

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

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

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

Allograft Prosthesis Composite (APC) for Proximal Humeral Bone Loss: Outcomes and Perspectives

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