Tikhoff-Linberg Procedure Research Articles

High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections.

The Tikhoff-Linberg procedure is a limb salvage technique for tumours of the shoulder girdle which preserves function of the hand and elbow; however, shoulder function is limited. A humeral cap endoprosthesis (Stryker Orthopedics, Mahwah, NJ, USA) was developed within the Modular Replacement System (MRS) to act as a functional spacer for these defects; however, the outcomes of this implant have not been described. Thirty-three (17 male, 16 female) patients underwent a Tikhoff-Linberg procedure at our institution. Of these, 17 (11 females, 6 males) were reconstructed with a MRS humerus endoprosthesis. Outcomes and complications were compared between patients who were reconstructed (n = 17) and those who were not (n = 16). Complications occurred in 14 (42%) patients, with more complications in patients who were reconstructed (n = 11, 65% vs. n = 3, 19%, p = 0.01). Endoprosthetic complications included stress shielding of the bone/prosthesis interface (n = 7, 41%) and subluxation/instability (n = 5, 29%), leading to a revision surgery in two (12%). Post-operatively, the mean Musculoskeletal Tumor Society Score (MSTS93) was 67 ± 11%, with no difference in the mean MSTS93 between patients who were reconstructed and those who were not (67 ± 10% vs. 68 ± 12%, p = 0.77). Reconstruction with a MRS humerus cap endoprosthesis resulted in a high rate of complications following a Tikhoff-Linberg procedure. Stress shielding and subluxation were common, and as such, the use of this prosthesis is limited to cases where a standard implant is not a feasible option.

Primary malignant tumours of the scapula--a review of 29 cases.

Primary malignant bone tumours of the scapula are very rare. Apart from limited small series and some case reports, international literature on flat bone sarcoma is exiguous and not much is known about the oncological outcome. A retrospective analysis of 29 patients diagnosed with a primary malignant tumour of the scapula was performed. The mean age was 40 years. The average time of follow-up was 60 months. Diagnoses included chondrosarcoma in 11 patients, Ewing's sarcoma/PNET in six, osteosarcoma in three, and others in nine. Five patients (19%) had no surgery. Wide resection was performed in 18 patients (74%) and marginal and intralesional resection in three patients (13%) each. Fifteen patients underwent resection without bony reconstruction, seven patients underwent a Tikhoff-Linberg procedure, and two patients received a custom-made scapula prosthesis. Six patients were diagnosed with metastasis after a mean time of nine months after surgery, while three patients suffered local recurrence at an average of six months after surgery. Disease-specific survival was 70% at one year and 47% at five years. The mean MSTS score was 69% and was highest for patients with scapular prosthesis. The overall prognosis of primary malignant bone tumours of the scapula remains to be inferior compared to extremity sarcoma. Endoprosthetic reconstruction, however, shows promising functional results even in cases of total scapulectomy.

Interscapulothoracic resection of tumours of shoulder with a note on reconstruction.

We retrospectively reviewed the outcomes of 33 consecutive patients who had undergone an extra-articular, total or partial scapulectomy for a malignant tumour of the shoulder girdle between 1 July 2001 and 30 September 2013. Of these, 26 had tumours which originated in the scapula or the adjacent soft tissue and underwent a classic Tikhoff-Linberg procedure, while seven with tumours arising from the proximal humerus were treated with a modified Tikhoff-Linberg operation. We used a Ligament Advanced Reinforcement System for soft-tissue reconstruction in nine patients, but not in the other 24. The mean Musculoskeletal Tumor Society score (MSTS) was 17.6 (95% confidence interval (CI) 15.9 to 19.4); 17.6 (95% CI 15.5 to 19.6) after the classic Tikhoff-Linberg procedure and 18.1 (95% CI 13.8 to 22.3) after the modified Tikhoff-Linberg procedure. Patients who had undergone a LARS soft-tissue reconstruction had a mean score of 18.6 (95% (CI) 13.9 to 22.4) compared with 17.2 (95% CI 15.5 to 19.0) for those who did not. The Tikhoff-Linberg procedure is a useful method for wide resection of a malignant tumour of the shoulder girdle which helps to preserve hand and elbow function. The method of soft-tissue reconstruction has no effect on functional outcome.

Modified Tikhoff-Linberg Procedure for Posterior Chest Wall Sarcoma

The Tikhoff-Linberg procedure was originally described more than 80 years ago as a limb-sparing surgical option for malignancies involving the shoulder girdle. However, involvement of the chest wall was a contraindication, consigning patients to either amputation or shoulder disarticulation. With the addition of prosthetic and autologous tissue reconstruction of the chest wall, this procedure is a viable option for an extended group of patients. The modified procedure offers an excellent functional result, leaving the patient with a fully functional arm and hand.

Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors

From 1981 to 2001, 91 shoulder resections were performed to treat shoulder girdle tumors (64 primary and 27 metastatic) in 90 patients (53 male and 37 female patients). The mean age was 34 years in patients with a primary tumor and 61 years in those with metastases. There were 7 partial scapulectomies, 13 total scapulectomies, 56 proximal humeral resections, 5 diaphyseal resections, 5 total shoulder girdle resections (Tikhoff-Linberg procedure), and 5 other procedures performed. Prosthesis implantation was carried out in 41 cases, autologous fibular transposition was done in 19, and massive homologous bone grafting was done in 4. Of the patients, 37 were clinically reviewed with a mean follow-up of 4.7 years (range, 1-20 years) by use of the recommendations of the Musculoskeletal Tumor Society for pain, function, position of hand, lifting ability, manual dexterity, and satisfaction. Nine patients were reviewed via a questionnaire and telephone interview. Twenty-six had died, and eighteen were lost to follow-up. The best results were achieved after partial scapulectomy and after humeral resection reconstructed with fibular transposition, when the function of the rotator cuff was preserved. After total scapulectomy and after humeral resection with the implantation of a tumor endoprosthesis, the function of the shoulder remained moderate because the rotator cuff was damaged. The overall satisfaction was generally good after all types of shoulder resections as a result of pain relief, preserved hand function, and improvement of psychological status. Patients can compensate extremely well by using the preserved joints and the contralateral upper limb; therefore, patient satisfaction does not rely on shoulder function alone.

208 POSTER Tikhoff Linberg procedure for tumors in the scapulo-humeral space. Experience at National Cancer Institute Mexico

208 POSTER Tikhoff Linberg procedure for tumors in the scapulo-humeral space. Experience at National Cancer Institute Mexico

Tikhoff-Linberg procedure and chest wall resection for recurrent sarcoma of the shoulder girdle involving the chest wall

Since the early 1980s, limb-sparing procedures have become the standard of care for the treatment of sarcoma involving the extremities. The Tikhoff-Linberg procedure has been described as a limb-sparing option for the treatment of neoplasms of the shoulder girdle. Historically, the involvement of the chest wall with tumor has been considered an absolute contraindication for this operation. We describe a case in which a recurrent sarcoma of the shoulder girdle with chest wall involvement was successfully treated with the Tikhoff-Linberg procedure modified to include chest wall resection, along with a simple reconstructive technique.

Cirurgia de tikhoff-linberg para tratamento de condrossarcoma localmente avançado da região escápulo-umeral

Chondrosarcoma is a rare malignant neoplasia that most of the time affects young adults. Its location is preferentially the pelvic and scapular girdle and surgery is its treatment of choice. There are no role for chemo or radiation therapy, because of their low index of response. We describe a case of a 45 year-old male patient with an extensive low grade right umerus chondrosarcoma. In spite of the local extension, there was no invasion of the shoulder neurovascular structures. Treatment proposed was the Tikhoff-Linberg procedure, and the operation was performed with success, with no complications. Free margins were obtained. The patient is now on two years follow-up with no evidence of recurrent disease and is able to drive, fish and carry packs. He can not abduct his arm, but he could not do that even before surgery, due to severe pain. We believe this is an excellent conservative approach to such tumors, that otherwise would require a forequarter amputation, and strongly recommend the technique.

Tikhoff-Linberg procedure for bone and soft tissue tumors of the shoulder girdle.

To evaluate complications and the oncological and intermediate-term functional results in patients with bone and soft tissue tumors of the shoulder girdle who were managed with interscapulothoracic resection (Tikhoff-Linberg procedure). Case series of 19 consecutive patients during a 10-year period at a mean follow-up of 6.3 years (range, 1-11 years). University hospital; referral center for musculoskeletal tumor surgery. The initial diagnosis in this consecutive series of patients with shoulder girdle tumors requiring the Tikhoff-Linberg procedure was chondrosarcoma in 7 patients, Ewing sarcoma in 3 patients, malignant fibrous histiocytoma in 3 patients, solitary metastasis of thyroid carcinoma in 2 patients, osteosarcoma, synovial sarcoma, angiosarcoma, ancd neurofibrosarcoma in 1 patient each. According to the Musculoskeletal Tumor Society staging system, there were 6 in surgical stage IB, 10 in stage IIB, and 3 in stage III. Nine tumors involved the proximal humerus, 8 were located in the scapula or surrounding soft tissues, 1 in the lateral clavicle, and 1 in the acromioclavicular joint. For reconstruction of the proximal humerus after en bloc tumor resection an isoelastic cemented shoulder tumor prosthesis was inserted in every patient to restore arm length. Complications, and oncological and intermediate-term functional results. Twelve patients were alive with no evidence of disease. One of these patients died of nontumorous disease 2 years after surgery. One patient is alive with pulmonary metastases after 12 months. Six patients died of metastases at a mean (SD) interval of 18 months (range, 3-35 months) postoperatively. Two of these patients had additional local recurrence. A deep infection necessitated the explantation of the prosthesis in 1 patient. The mean functional score and SD according to the rating system of the Musculoskeletal Tumor Society was 72%+/-14% (range, 33%-87%) for the 12 surviving patients evaluated. Major complications (1 infection and 2 local recurrences) that may be attributed to the procedure occurred in 3 of the 19 patients. Despite an overall complication rate of 74% the Tikhoff-Linberg procedure proved to be a valuable surgical procedure for extended tumors of the shoulder girdle for functional and oncological outcome and is superior to forequarter amputation.

Radical scapulectomy with limb salvage for shoulder girdle soft tissue sarcoma

Limb-sparing surgical procedures, such as the Tikhoff-Linberg resection, have gradually replaced the forequarter amputation as the surgical treatment of choice for soft tissue tumours in and around the shoulder girdle. Although the Tikhoff-Linberg procedure provides limb salvage, it leaves a significant functional and cosmetic deficit in many patients. Scapular resections combined with radical excision of the soft tissues allows wide margins of resection, limited excision of uninvolved bone and excellent physical rehabilitation in treating soft tissue tumours of the shoulder girdle. The case of a young woman with Stage IVA malignant fibrous histiocytoma of the left shoulder girdle who underwent a radical scapulectomy with limb salvage and adequate surgical margins, while preserving a functional and cosmetically acceptable extremity, is reported. A historical review of scapular resections is also presented.

Traumatic dislocation of the lumbar spine at two levels

Ablation of the scapula as a result of trauma has not, to our knowledge, been described previously. The use of the pedicled latissimus dorsi myocutaneous flap in reconstructing soft tissue defects in the shoulder region is well described (Dowden and McCraw, 1980; Cohen, 1985). In our case, the latissimus dorsi flap was used to provide not only soft tissue cover, but also a muscle transfer to replace the lost deltoid muscle, thus providing antigravity action and also a small amount of active shoulder extension. This has resulted in a stable, pain-free shoulder which has descended minimally in the intervening 18 months, and has some similarities to the 'muscle sling' concept described to prevent a hanging shoulder after radical scapulectomy or the Tikhoff-Linberg procedure (Kurer et al., 1988). The use of K6ntscher nail fixation of the humerus to the second rib or to the end of the clavicle for the same purpose has also been described (Marcove et al., 1977). References

The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical “extensive” technique versus a modified “transglenoid” resection

The authors report on two groups of patients (each with 12) with primary bone tumors of the humerus who underwent either a classical Tikhoff-Linberg (T-L) procedure or a modified technique by which the body of the scapula was saved. The latter procedure was an "en bloc" resection of the glenohumeral joint after an extra-capsular osteotomy of the neck of the scapula, followed by reconstruction with a modular prosthesis. Indications, perioperative differences, and complications of both procedures are discussed. Besides producing better aesthetic and functional results, the modified technique offered the advantages of shorter anesthesia time, less blood loss, and a better anchorage of the prosthesis. The results of this study show that the proposed modification of the T-L procedure is indicated in patients with bone tumors of the proximal humerus in which invasion of the joint capsule is present without macroscopic involvement of the glenoid.

Treatment of bone tumors around the shoulder joint by the Tikhoff-Linberg procedure

The Tikhoff-Linberg procedure is a limb-sparing surgical option to be considered for bony and soft tissue tumors in and around the proximal humerus and shoulder girdle. The authors reported 6 cases of the Tikhoff-Linberg procedure for tumors around the shoulder joint at the Department of Orthopedic Surgery of Severance Hospital from March 1988 to May 1989. The results of the study are as follows: The 6 cases were composed of: osteogenic sarcoma 2 cases, chondrosarcoma 2 cases, chondroblastoma 1 case, and giant cell tumor 1 case. The tumors were completely removed by the Tikhoff-Linberg procedure without amputation or disarticulation of the upper extremity. The distal clavicle, upper humerus and part of all of the scapula were resected. The Tikhoff-Linberg procedure was performed for patients whose tumors did not involve the neurovascular bundle in the axilla. The function of the hand and forearm after the Tikhoff-Linberg procedure was nearly normal in all cases. The Tikhoff-Linberg procedure would be recommended as a limb-sparing operation for tumors around the shoulder joint that require wide resection without disarticulation or forequarter amputation of the upper extremities.

A humeral modular prostheses for bone tumour surgery: a study of 56 cases.

Fifty six humeral prostheses were inserted from 1974 to 1984 for primary bone tumours of the shoulder. In 40 patients a proximal humeral resection was performed and in the remaining 16 cases a Tikhoff-Linberg procedure was employed. The length of humeral resection ranged from 9 cm to 24 cm. A detailed analysis of the oncological and functional results was made. The resection was well clear in 42 patients (75%), marginal in 12 (21.5%), and through tumour in 2 (3.5%). Eight local recurrences were noted. The functional results were satisfactory, the patients having a wide range of active rotation and being able to do sedentary work. A new modified humeral modular prosthesis was introduced in 1984 and is presented.

Tikhoff procedure in recurrent chondrosarcoma following free vascularised fibular graft

A forty year old housewife presented with a recurrent chondrosarcoma in a vascularised fibular transplant for a tumour in the proximal humerus. The Tikhoff-Linberg procedure was carried out with satisfactory results. The case report serves to emphasize the need to be aggressive in the initial management of malignant bone tumours. Careful planning and execution of a further aggressive procedure in the presence of a recurrence, ensures adequate clearance of tumour while still preserving a functional and useful limb.

Tikhoff Procedure in Recurrent Chondrosarcoma Following Free Vascularised Fibular Graft

A forty year old housewife presented with a recurrent chondrosarcoma in a vascularised fibular transplant for a tumour in the proximal humerus. The Tikhoff-Linberg procedure was carried out with satisfactory results. The case report serves to emphasize the need to be aggressive in the initial management of malignant bone tumours. Careful planning and execution of a further aggressive procedure in the presence of a recurrence, ensures adequate clearance of tumour while still preserving a functional and useful limb.