Original Research

Treating Humeral Bone Loss in Shoulder Arthroplasty: Modular Humeral Components or Allografts

Publish date: February 15, 2018

TAKE-HOME POINTS

Proximal humeral bone loss presents a significant challenge for the shoulder arthroplasty surgeon.
Unsupported long-stemmed humeral components in this setting are prone to early loosening.
APCs can rebuild proximal humeral bone stock, but have concerns with graft resorption and long-term failure.
Modular endoprosthetic reconstruction of proximal humeral bone loss potentially allows those deficiencies to be addressed in a more durable fashion.
Longer-term and larger studies are needed to determine the optimal reconstruction technique for proximal humeral bone loss.

References

1. Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am. 2009;91(1):119-127. doi:10.2106/JBJS.H.00094.

2. Hattrup SJ, Waldrop R, Sanchez-Sotelo J. Reverse total shoulder arthroplasty for posttraumatic sequelae. J Orthop Trauma. 2016;30(2):e41-e47. doi:10.1097/BOT.0000000000000416.

3. Sewell MD, Kang SN, Al-Hadithy N, et al. Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement. J Bone Joint Surg Br. 2012;94(10):1382-1389. doi:10.1302/0301-620X.94B10.29248.

4. Trompeter AJ, Gupta RR. The management of complex periprosthetic humeral fractures: a case series of strut allograft augmentation, and a review of the literature. Strategies Trauma Limb Reconstr. 2013;8(1):43-51. doi:10.1007/s11751-013-0155-x.

5. Khatib O, Onyekwelu I, Yu S, Zuckerman JD. Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization. J Shoulder Elbow Surg. 2015;24(10):e286-e291. doi:10.1016/j.jse.2015.05.038.

6. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249-2254. doi:10.2106/JBJS.J.01994.

7. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck CD, Cofield RH. Survivorship of the humeral component in shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(1):143-150. doi:10.1016/j.jse.2009.04.011.

8. Wright TW. Revision of humeral components in shoulder arthroplasty. Bull Hosp Jt Dis. 2013;71(2 suppl):S77-S81.

9. Duquin TR, Sperling JW. Revision shoulder arthroplasty—how to manage the humerus. Oper Tech Orthop. 2011;21(1):44-51. doi:10.1053/j.oto.2010.09.008.

10. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br. 2009;91(1):75-81. doi:10.1302/0301-620X.91B1.21094.

11. Cofield RH. Revision of hemiarthroplasty to total shoulder arthroplasty. In: Zuckerman JD, ed. Advanced Reconstruction: Shoulder. 1st edition. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007;613-622.

12. Budge MD, Moravek JE, Zimel MN, Nolan EM, Wiater JM. Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary? J Shoulder Elbow Surg. 2013;22(6):739-744. doi:10.1016/j.jse.2012.08.008.

13. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997;79(5):857-865.

14. Throckmorton TW. Reconstructive procedures of the shoulder and elbow. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s Operative Orthopaedics. 13th edition. Philadelphia, PA: Elsevier; 2017;570-622.

15. Williams GR Jr, Wong KL, Pepe MD, et al. The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement. J Shoulder Elbow Surg. 2001;10(5):399-409. doi:10.1067/mse.2001.116871.

16. De Wilde L, Walch G. Humeral prosthetic failure of reversed total shoulder arthroplasty: a report of three cases. J Shoulder Elbow Surg. 2006;15(2):260-264. doi:10.1016/j.jse.2005.07.014.

17. Owens CJ, Sperling JW, Cofield RH. Utility and complications of long-stem humeral components in revision shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(7):e7-e12. doi:10.1016/j.jse.2012.10.034.

18. Stephens SP, Paisley KC, Giveans MR, Wirth MA. The effect of proximal humeral bone loss on revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2015;24(10):1519-1526. doi:10.1016/j.jse.2015.02.020.

19. Werner BS, Abdelkawi AF, Boehm D, et al. Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems. J Shoulder Elbow Surg. 2017;26(2):273-278. doi:10.1016/j.jse.2016.05.015.

20. Cuff D, Levy JC, Gutiérrez S, Frankle MA. Torsional stability of modular and non-modular reverse shoulder humeral components in a proximal humeral bone loss model. J Shoulder Elbow Surg. 2011;20(4):646-651. doi:10.1016/j.jse.2010.10.026.

21. Kassab M, Dumaine V, Babinet A, Ouaknine M, Tomeno B, Anract P. Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(1):15-23.

22. Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg. 2007;98(2):292-300. doi:10.2106/JBJS.E.01310.

23. Gagey O, Pourjamasb B, Court C. Revision arthroplasty of the shoulder for painful glenoid loosening: a series of 14 cases with acromial prostheses reviewed at four year follow up. Rev Chir Reparatrice Appar Mot. 2001;87(3):221-228.

24. Abdeen A, Hoang BH, Althanasina EA, Morris CD, Boland PJ, Healey JH. Allograft-prosthesis composite reconstruction of the proximal part of the humerus: functional outcome and survivorship. J Bone Joint Surg Am. 2009;91(10):2406-2415. doi:10.2106/JBJS.H.00815.

25. Getty PJ, Peabody TD. Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am. 1999;81(8):1138-1146.

26. Chen CF, Chen WM, Cheng YC, Chiang CC, Huang CK, Chen TH. Extracorporeally irradiated autograft-prosthetic composite arthroplasty using AML® extensively porous-coated stem for proximal femur reconstruction: a clinical analysis of 14 patients. J Surg Oncol. 2009;100(5):418-422. doi:10.1002/jso.21351.

27. Kelly JD 2nd, Purchase RJ, Kam G, Norris TR. Alloprosthetic composite reconstruction using the reverse shoulder arthroplasty. Tech Shoulder Elbow Surg. 2009;10(1):5-10.

28. Cannon CP, Paraliticci GU, Lin PP, Lewis VO, Yasko AW. Functional outcome following endoprosthetic reconstruction of the proximal humerus. J Shoulder Elbow Surg. 2009;18(5):705-710. doi:10.1016/j.jse.2008.10.011.

29. Chao EY, Fuchs B, Rowland CM, Ilstrup DM, Pritchard DJ, Sim FH. Long-term results of segmental prosthesis fixation by extracortical bone-bridging and ingrowth. J Bone Joint Surg Am. 2004;86-A(5):948-955.

30. Goulding KA, Schwartz A, Hattrup SJ, et al. Use of compressive osseointegration endoprostheses for massive bone loss from tumor and failed arthroplasty: a viable option in the upper extremity. Clin Orthop Relat Res. 2017;475(6):1702-1711. doi:10.1007/s11999-017-5258-0.

31. Guven MF, Aslan L, Botanlioglu H, Kaynak G, Kesmezacar H, Babacan M. Functional outcome of reverse shoulder tumor prosthesis in the treatment of proximal humeral tumors. J Shoulder Elbow Surg. 2016;25(1):e1-e6. doi:10.1016/j.jse.2015.06.012.

32. Wang ML, Ballard BL, Kulidjian AA, Abrams RA. Upper extremity reconstruction with a humeral tumor endoprosthesis: a novel salvage procedure after multiple revisions of total shoulder and elbow replacement. J Shoulder Elbow Surg. 2011;20(1):e1-e8. doi:10.1016/j.jse.2010.07.018.

References

2. Hattrup SJ, Waldrop R, Sanchez-Sotelo J. Reverse total shoulder arthroplasty for posttraumatic sequelae. J Orthop Trauma. 2016;30(2):e41-e47. doi:10.1097/BOT.0000000000000416.

6. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249-2254. doi:10.2106/JBJS.J.01994.

8. Wright TW. Revision of humeral components in shoulder arthroplasty. Bull Hosp Jt Dis. 2013;71(2 suppl):S77-S81.

9. Duquin TR, Sperling JW. Revision shoulder arthroplasty—how to manage the humerus. Oper Tech Orthop. 2011;21(1):44-51. doi:10.1053/j.oto.2010.09.008.

13. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997;79(5):857-865.

16. De Wilde L, Walch G. Humeral prosthetic failure of reversed total shoulder arthroplasty: a report of three cases. J Shoulder Elbow Surg. 2006;15(2):260-264. doi:10.1016/j.jse.2005.07.014.

27. Kelly JD 2nd, Purchase RJ, Kam G, Norris TR. Alloprosthetic composite reconstruction using the reverse shoulder arthroplasty. Tech Shoulder Elbow Surg. 2009;10(1):5-10.

Use of a Novel Magnesium-Based Resorbable Bone Cement for Augmenting Anchor and Tendon Fixation

Treating Humeral Bone Loss in Shoulder Arthroplasty: Modular Humeral Components or Allografts

TAKE-HOME POINTS

References

ABSTRACT

Pages

Next Article: