The Use of Tumor Prostheses for Primary or Revision Reverse Total Shoulder Arthroplasty With Proximal Humeral Bone Loss

Abstract

Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS ( P = .03) and ASES score ( P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.

Functional outcomes after reverse shoulder megaprosthesis following resection of malignant bone tumor in the proximal humerus: a systematic review and meta-analysis

“…This systematic review included 9 studies. 5 , 17 , 24 , 26 , 28 , 33 , 41 , 61 , 63 The study characteristics are shown in Table I .…”

“…17 , 28 , 33 , 61 Seven studies did not have consecutive inclusion of patients, because of a retrospective design. 5 , 17 , 26 , 33 , 41 , 61 , 63 Two studies did not clearly report outcomes, as they did not report individual patient data. 28 , 33 Four studies did not clearly report site clinic demographic information, as no information was provided about the center or the surgeons.…”

“… 28 , 33 Four studies did not clearly report site clinic demographic information, as no information was provided about the center or the surgeons. 17 , 33 , 41 , 61 …”

“…Insertion resected, n = 4. Identified and respected Yes 42 (24-84) 8 55 (28-82) Grosel et al, 2019 24 Case series PD, M, and enchondroma If possible repaired to humeral component Likely partial denervation of deltoid No 20,9 (SD: 12) 10 64 (SD: 11,2) Guven et al, 2016 26 Cohort PD, M, and giant cell tumor Remaining deltoid 85% (18,9) 1 patient with nerve damage Yes 18,2 (6-27) 10 49,4 (31-70) Houdek et al, 2021 28 Case series PD and M Resection below insertion in 7 (23%) Axillary nerve killed in 2 (7%) Yes 84 (SD: 48) 20 61 (SD: 19) Kaa et al, 2013 33 Case series PD, M, and aneurysmatic bone cyst Reattached to prosthesis NA Yes 46,4 (12-136) 10 42 (19-79) Mengers et al, 2022 41 Case series Tumor not specified Preserved n = 8, repair n = 9 NA Yes 33,7 (18-70) 13 68,4 (39-88) Streitbuerger et al, 2015 61 Case series PD, M, and giant cell tumor Reattached to prosthesis 2 complete transection 2 partial Yes 33,6 (4-108) 17 42 (14-70) Trovarelli et al, 2019 63 Case series PD and M Preserved Preserved Yes 39 (12-94) 22 55 (18-71) …”

“…28,33 Four studies did not clearly report site clinic demographic information, as no information was provided about the center or the surgeons. 17,33,41,61 One study described that ROM was assessed by the same researcher using a goniometer. 33 One study describes that ROM was assessed by multiple physicians over time using a goniometer.…”