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

Abstract

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.

Allograft reconstruction of olecranon after traumatic bone loss: a case report

“…In a review of twenty-five patients undergoing reverse shoulder-allograft prosthesis composite at the proximal humerus, the allograft-host junction demonstrated incorporation in 96% of the cases 2 . In another study of 23 patients receiving elbow allografts (1 olecranon allograft, 6 distal J o u r n a l P r e -p r o o f humerus allografts, and 16 total elbow allografts including ligamentous aspects) only 1 nonunion was reported 3 .…”

“…Even more uncommon was the use of moderate sized allografts at hemiarticular locations such as the olecranon 11 . However, the limited information that exist on postoperative outcomes of graft incorporation at the proximal ulna has been optimistic 2,3,10,11 .…”

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

“…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. The patients in these respected studies had similar improvements in pain reduction and shoulder motion as the patients presented in the current study 15,33 …”

“…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. The patients in these respected studies had similar improvements in pain reduction and shoulder motion as the patients presented in the current study 15,33 …”

EEG-Based BCI System to Control Prosthesis's Finger Movements

“…Existing prosthetics are electric or mechanical, which are controlled using intentional motor activity to restore the mobility of the amputated part. For instance, a prosthetic hand can be controlled with a shoulder using a harness [6,7]. Electric prosthetics are controlled using the residual activity of nerves or muscles in the extremity of the amputated area.…”