Shoulder arthroplasty in patients with prior mastectomy for breast cancer

Andrews, Laura R.; Cofield, Robert H.; O’Driscoll, Shawn W.

doi:10.1067/mse.2000.106468

Cited by 10 publications

(16 citation statements)

References 5 publications

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“…Despite these limitations, this study identified more encouraging results in patients undergoing shoulder arthroplasty after prior ALND than have been previously reported. 8 Our results suggest that patients who elect to undergo shoulder arthroplasty after ALND may expect a consistent outcome with a lower complication and revision rate than previously reported.…”

Section: Discussionsupporting

confidence: 75%

“…[14][15][16] In the most recent analysis, a rate of 3.5% after a sentinel lymph node biopsy and 19.1% after complete removal of all axillary lymph nodes was reported. 17 The only previous literature on the topic by Andrews et al 8 reported results of patients undergoing shoulder arthroplasty after prior breast cancer treatment. Between 1979 and 1996, the authors identified 17 patients who had undergone mastectomy for breast cancer prior to shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of guiding literature on this population. An older study by Andrews et al 8 evaluated a group of patients who underwent shoulder arthroplasty after prior ALND between the years of 1979 and 1996.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of shoulder arthroplasty following axillary lymph node dissection

et al. 2018

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Introduction Shoulder arthroplasty with previous axillary lymph node dissection historically has unsatisfactory outcomes. We analyzed outcomes of primary shoulder arthroplasty in patients with previous axillary lymph node dissection. Methods Thirty-two primary shoulder arthroplasties after prior axillary lymph node dissection were performed. These patients were analyzed for patient-reported outcomes, range of motion, complications, and reoperations. Results Average age was 70.8 ± 7.5 years old. There were 19 anatomic total shoulder arthroplasties, four hemiarthroplasties, and nine reverse total shoulder arthroplasties. Eight were performed by a superior approach while 24 were performed by a deltopectoral approach with cephalic vein preservation. There were three complications (one deltoid dehiscence, one axillary nerve palsy, and one postoperative pneumonia). There was one revision (hemiarthroplasty to reverse total shoulder arthroplasty for cuff failure at 91 weeks), two reoperations, and no infections. Patient-reported outcomes were available for 21/26 (80.1%) of the surviving shoulders at 4.8 ± 2.0 years. Average visual analog scale pain score was 7.1 ± 14.5, Simple Shoulder Test score 8.3 ± 2.6 “yes” responses, Single Assessment Numeric Evaluation score 80.2 ± 17.4, and American Shoulder and Elbow Surgeons score 83.6 ± 14.1. Conclusion Axillary lymph node dissection is not a contraindication to shoulder arthroplasty. A deltopectoral exposure can be utilized without substantial risk of worsening lymphedema or wound complications. While a superior approach avoids cephalic vein injury, important approach-related complications (deltoid dehiscence and axillary nerve palsy) were observed. Level of evidence: Level IV—case series.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Outcomes of shoulder arthroplasty following axillary lymph node dissection

et al. 2018

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“…21 Postradiation necrosis seems to be an important risk factor for periprosthetic infection, with an infection rate of up to 25%. 1,21 Revision surgery, arthroplasty for fracture sequelae, and a history of instability surgery constitute other risk factors for infection. Even with adequate treatment, the cure rate of periprosthetic infection remains disappointing, and the functional prognosis is often compromised.…”

Section: Infectionmentioning

confidence: 99%

Complications of unconstrained shoulder prostheses

Gonzalez

Alami

Baqué

et al. 2011

Journal of Shoulder and Elbow Surgery

188

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“…Shrader and Morrey 5 reported knee arthroplasty in patients with lower extremity lymphedema, demonstrating improved functional scores but a 31% complication rate. Similarly, Andrews et al 6 reported on effect of anatomic shoulder arthroplasty and shoulder hemiarthroplasty in patients with upper extremity lymphedema. The study group had improved pain after surgery but minimal change in range of motion and a high complication rate.…”

Section: Introductionmentioning

confidence: 93%

Shoulder arthroplasty in patients with upper extremity lymphedema may result in transient or permanent lymphedema worsening

et al. 2019

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Introduction Upper extremity lymphedema can complicate mastectomy, lymph node dissection, and radiation. The purpose of this study is to present the outcomes of shoulder arthroplasty in patients with lymphedema. Methods The 19 shoulders with a shoulder arthroplasty and lymphedema on the surgical side (6 anatomic, 12 reverse, 1 hemiarthroplasty) were followed for four years (1–10 years). There were 2 males and 17 females; average age was 67.8 (48–86) years. Breast carcinoma was the most common reason for lymphedema (75%). A dedicated lymphedema questionnaire could be completed for 14 shoulders. Results Pain improved from moderate or severe preoperatively to no or mild in 18 shoulders. Motion improved in elevation (55° preoperatively, 107° at last follow-up), external rotation (14°, 43°), and internal rotation (sacrum, L5). Complications included an acromion stress fracture with a deep infection (1), deep infection (1), superficial infection (1), and glenoid loosening (1). Lymphedema worsened in nine cases, but worsening was permanent in only four. Currently, lymphedema treatment is being performed by 93% of survey respondents. No patients reported lymphangitis or lymphangiosarcoma. Conclusion Shoulder arthroplasty for an upper extremity with lymphedema provides substantial improvements in pain and motion; however, infection is a concerning complication. Fifty percent of the patients will experience worsening of their lymphedema and in 20% worsening may be permanent.

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Shoulder arthroplasty in patients with prior mastectomy for breast cancer

Cited by 10 publications

References 5 publications

Outcomes of shoulder arthroplasty following axillary lymph node dissection

Outcomes of shoulder arthroplasty following axillary lymph node dissection

Complications of unconstrained shoulder prostheses

Shoulder arthroplasty in patients with upper extremity lymphedema may result in transient or permanent lymphedema worsening

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