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Abstract
Simple SummaryThe soft tissue reconstruction around proximal or total humeral megaprostheses following limb-sparing resection of a primary malignant bone tumor can be a challenge. A surgical technique to overcome these challenges is the Bateman-type soft tissue reconstruction, which is performed as a lateral acromion and trapezoid transfer aiming to improve soft tissue coverage and postoperative function. However, the functional outcome and the endoprosthetic complications of this procedure have hardly been evaluated. Our study shows that the Bateman-type reconstruction is a feasible treatment option, but the postoperative functional outcome is overall limited although good to excellent functional results can be achieved in individual patients. The risk for revision surgery is high within the first year, but remains low thereafter.We aimed to evaluate the functional outcome and endoprosthetic complications following the Bateman-type soft tissue reconstruction around proximal or total humeral replacements in patients undergoing resection of a primary malignant bone tumor. Between September 2001 and December 2018, a total of 102 patients underwent resection of a primary malignant bone tumor and subsequent reconstruction with a modular humeral megaprosthesis in our department. Fifteen (15%) of these patients underwent a Bateman-type soft tissue reconstruction and were included in this retrospective study. The median Musculoskeletal Tumor Society (MSTS) score was 21, the median Toronto Extremity Salvage Score (TESS) was 70, and the median American Shoulder and Elbow Surgeons (ASES) score was 72. Fifty-three percent (8/15) of all patients required a revision surgery after a median time of 6 months. There were 2 soft tissue failures, 3 infections and 3 tumor recurrences. The revision-free implant survivorship amounted to 53% (95% confidence interval (CI) 28–81) after 1 year and 47% (95% CI 22–73) at last follow-up. The Bateman-type reconstruction is a feasible option for soft tissue reconstruction but functional outcome is overall limited and the risk for revision surgery within the first postoperative year is high.
Highlights
The humerus is a common site for primary malignant bone tumors [1]
While long-term implant survivorship of proximal or total humeral replacements can be considered good, soft tissue failures such as dislocation, migration and problematic implant coverage are the main cause of revision surgery [5,7,8]
No differences in functional outcome scores were found for the 3 patients undergoing an intra- or extra-articular tumor resection, respectively or the 3 patients who underwent an anatomic or reverse shoulder reconstruction, respectively (Table 3)
Summary
While there are several multimodal treatment protocols that are adapted depending on tumor histology, tumor resection with a wide margin is considered the gold standard surgical treatment [2]. In the majority of cases, a limb-sparing resection is possible, but surgeons are subsequently challenged with the reconstruction of the segmental bone defect and the adjacent shoulder joint [3]. Endoprosthetic replacement using a modular megaprosthesis has evolved as a favorable and widely used approach for reconstruction [4,5,6]. While long-term implant survivorship of proximal or total humeral replacements can be considered good, soft tissue failures such as dislocation, migration and problematic implant coverage are the main cause of revision surgery [5,7,8]. Functional outcome in these patients can be limited [9,10,11,12]
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