Do reverse total shoulder replacements have better clinical and functional outcomes than hemiarthroplasty for patients undergoing proximal humeral tumor resection using devitalized autograft composite reconstruction: a case-control study

Dongqing Zuo,Chuanping Li,Chuanping Li,Chuanping Li,Chongren Wang,Jiakang Shen,Qingbo Yang,Qingbo Yang,Mengxiong Sun,Zhengdong Cai,Xiaojun Ma,Hongsheng Wang,Wei Sun,Haoran Mu

doi:10.1186/s13018-021-02488-1

Abstract

ObjectiveTo compare the efficacy and prognosis of reverse total shoulder arthroplasty (rTSA) with shoulder hemiarthroplasty (SHA) using devitalized autograft or allograft composite reconstruction after proximal humeral tumor resection.MethodsWe retrospectively reviewed patients who underwent SHA (32) and rTSA (20) for tumor resections of the proximal humerus from January 2014 to July 2020. The clinical results included duration of the operation, intraoperative blood loss, bone union, visual analog scale (VAS) score, shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) shoulder score, recurrence, and overall survival.ResultsFifty-two patients were followed up for a mean of 30 months. Thirty-two patients were SHA with allograft-prosthetic composite (APC) reconstructions, while other 20 were rTSA with devitalized autograft-prosthetic composite reconstructions. At the end of the follow-up, 2 recurrence, 3 postoperative infections, and 4 subluxations occurred among the SHA patients. Two patients in the rTSA group had postoperative anterior dislocation and underwent revision surgery with surgical mesh, and 2 (2/20) had grade II scapular notching. The mean VAS score of the shoulder was 1.5 ± 0.8 in the rTSA group and 2.3 ± 1.2 in the SHA group (p < 0.05). The mean active forward flexion of the shoulder joint was 50.6 ± 6.0 in the SHA group and 100 ± 7.6 in the rTSA group (p < 0.05). The ASES shoulder score was 78 ± 3.0 in the rTSA group and 52 ± 5.6 in the SHA group (p < 0.05). The overall 3-year survival rate of all patients was 60.0%, and patients in the rTSA group showed better survival in terms of the mean 3-year OS than patients in the SHA group (p = 0.04).ConclusionrTSA with devitalized autograft-prosthetic composite can offer a reasonable reconstruction of the shoulder joint after Malawer type I tumor resection. Compared with patients who underwent SHA, patients who underwent rTSA present good outcomes, a better range of motion, better bone union, and no increase in instability rate in the mid-term.

Highlights

The proximal humerus is a common location for both primary and metastatic bone tumors, the second most common site for all osseous sarcomas and the third most common site for osteosarcoma [1, 2]
Conclusion: reverse total shoulder arthroplasty (rTSA) with devitalized autograft-prosthetic composite can offer a reasonable reconstruction of the shoulder joint after Malawer types: intraarticular proximal humerus resection (type I) tumor resection
Many reconstruction and stabilization options are available after principle surgical management, including allografts, allograft-prosthetic composites (APCs), mega-prostheses, and more recently, reverse total shoulder arthroplasty

Summary

Introduction

The proximal humerus is a common location for both primary and metastatic bone tumors, the second most common site for all osseous sarcomas and the third most common site for osteosarcoma [1, 2]. Tumor characteristics, and anatomic involvement are important factors to consider when selecting the optimal reconstruction. The function of the affected limb can be acceptable even if shoulder elevation is restricted. There is no consensus regarding the best reconstructive technique following proximal humerus resection. Limb salvage therapy for tumors of the shoulder is extremely challenging because the shoulder girdle is essentially an unstable anatomical structure requiring complex static (scapula, clavicle, humerus, joint capsule, ligaments, etc.) and dynamic stabilization systems (deltoid muscles, rotator cuffs) to maintain performance, which are affected following extensive surgical resection during shoulder tumor resection [4]. It is worth noting that the type of resection does not depend on the reconstruction method and that extra-articular resection (IV ~ VI type) is important for cases where tumors may involve the shoulder joints

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Conclusion