Abstract
Purpose: We conducted a retrospective review to evaluate outcomes, complications and implant survival after shoulder reconstruction for bone neoplasm using anatomic shoulder prostheses.
Method: Thirty-four anatomic shoulder prostheses were reviewed at an average follow-up of 51 (range, 6 to 143) months. The mean age at the time of surgery was 47 (range, 15 to 74) years. Twenty-five patients (74%) had reconstruction with an allograft-prosthetic composite (APC). The average amount of humerus resected in patients with an APC was 13 cm (range, 5 to 36 cm).
Results: At most recent follow-up, 82% of patients had no pain (11), slight pain (12) or moderate pain with strenuous activities (5). Twenty-eight patients (82%) were subjectively satisfied despite only 29% being satisfactory according to Neer rating. Sixteen complications occurred in 13 patients, including instability (5), host/graft non-union (3), aseptic loosening (3), arthrofibrosis (1), tumor recurrence (2) and superficial infection (1). Host/graft nonunion occurred in 3/9 patients with an APC using press-fit or plate fixation for distal humeral fixation and 0/16 shoulders with cemented distal humeral fixation (p=0.02). Three implants required revision for aseptic loosening (1), host/graft nonunion (1) and instability (1). Kaplan-Meier survivorship at 10 years was 88% for implant revision and 80% for mechanical failure.
Conclusion: Reconstruction of the proximal humerus using an anatomic prosthesis after resection of bone neoplasms is associated with a low rate of mechanical failure but a moderate rate of shoulder instability. Cement fixation into the native distal humerus should be considered when reconstruction using an APC is required.
Correspondence should be addressed to Meghan Corbeil, Meetings Coordinator Email: meghan@canorth.org
