High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap
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ORIGINAL PAPER
High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections Adam J. Tagliero 1 & Brandon R. Bukowski 1 & Peter S. Rose 1 & Mark E. Morrey 1 & Bassem T. Elhassan 1 & Jonathan D. Barlow 1 & Eric R. Wagner 2 & Joaquin Sanchez-Sotelo 1 & Matthew T. Houdek 1 Received: 29 January 2020 / Accepted: 17 April 2020 # SICOT aisbl 2020
Abstract Introduction 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. Methods 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). Results 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). Conclusions 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. Keywords Tikhoff-Linberg . Endoprosthesis . Reconstruction . Outcome
Level of evidence: Level IV * Matthew T. Houdek [email protected]
Jonathan D. Barlow [email protected]
Adam J. Tagliero [email protected]
Eric R. Wagner [email protected]
Brandon R. Bukowski [email protected]
Joaquin Sanchez-Sotelo [email protected]
Peter S. Rose [email protected] 1
Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
2
Department of Orthopedic Surgery, Emory University, 59 Executive Park, Suite 2000, Atlanta, GA 30029, USA
Mark E. Morrey [email protected] Bassem T. Elhassan [email protected]
International Orthopaedics (SICOT)
Introduction Amputative procedures of the shoulder girdle result in a substantial functional impact on the patient. As such, limb salvage surgery is pursued whenever possible. Although limb salvage surgery is the treatment of choice, it is technically challenging f
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