Skip to main content
SpringerLink
Log in

Improvement of the shoulder function after large segment resection of the proximal humerus with the use of an inverse tumour prosthesis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Active shoulder function after segmental tumour resection of the proximal humerus and endoprosthetic reconstruction is regularly compromised, while the overall arm function allows a satisfying use in daily activities. The main functional problem remains the loss of huge parts of the shoulder girdle musculature and its bony attachment. In revision arthroplasty inverse shoulder implants can improve the active range of motion significantly in comparison to anatomical shaped prostheses. The aim of this study was to investigate if these promising experiences are transferable to reconstructions after tumour resection of the proximal humerus by using a modular inverse tumour prosthesis.

Methods

In this study we observed the functional and oncological results of 18 inverse proximal humerus endoprosthetic replacements (IPHP) with the MUTARS system (Implantcast®) after resection of benign (1x giant cell) and malignant (11x primary bone sarcoma, 5x bone metastasis of carcinoma) bone tumours. Mean age at operation was 42 years. The mean postoperative follow-up was 33 months (range ten to 120).

Results

Resection margins were wide in 13 and marginal in five patients. Mean reconstruction length was 15.1 cm (range 6–25 cm). Mean operation time was 191 minutes. The axillary nerve was mostly preserved in 78 % (n = 14). At latest follow-up the patients presented a medium MSTS-score of 24.6/30. The mean active arm abduction in the shoulder joint was 78° and 88° active arm elevation for patients with intact axillary nerve function, but significantly reduced for the four patients with compromised deltoid function. One patient needed a surgical revision due to a deep implant infection.

Conclusions

The IPHP offers a significant improvement of active shoulder function in patients in whom the axillary nerve can be preserved in comparison to anatomically-shaped implants. However, for patients without any deltoid function there is no benefit regarding an improved active range of motion using an IPHP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Campanacci M (1999) Bone and soft tissue tumors, 2nd edn. Springer-Verlag, Wien

    Book  Google Scholar 

  2. Fottner A, Szalantzy M, Wirthmann L et al (2010) Bone metastases from renal cell carcinoma: patient survival after surgical treatment. BMC Musculoskelet Disord 11:145

    Article  PubMed Central  PubMed  Google Scholar 

  3. Gosheger G, Gebert C, Ahrens H et al (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171

    Article  PubMed  Google Scholar 

  4. Mittermayer F, Krepler P, Dominkus M et al (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177

    Article  PubMed  Google Scholar 

  5. Sluga M, Windhager R, Lang S et al (1999) Local and systemic control after ablative and limb sparing surgery in patients with osteosarcoma. Clin Orthop Relat Res 358:120–127

    Article  PubMed  Google Scholar 

  6. Gosheger G, Goetze C, Hardes J et al (2008) The influence of the alloy of megaprostheses on infection rate. J Arthroplasty 23:916–920

    Article  PubMed  Google Scholar 

  7. Hardes J, Ahrens H, Gebert C et al (2007) Lack of toxicological side-effects in silver-coated megaprostheses in humans. Biomaterials 28:2869–2875

    Article  CAS  PubMed  Google Scholar 

  8. Hardes J, von Eiff C, Streitbuerger A et al (2010) Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 101:389–395

    PubMed  Google Scholar 

  9. Streitburger A, Henrichs M, Hardes J et al (2012) Endoprosthetic reconstruction of the proximal humerus in malignoma. Oper Orthop Traumatol 24:174–185

    Article  CAS  PubMed  Google Scholar 

  10. Rodl RW, Gosheger G, Gebert C et al (2002) Reconstruction of the proximal humerus after wide resection of tumours. J Bone Joint Surg Br 84:1004–1008

    Article  CAS  PubMed  Google Scholar 

  11. Kumar D, Grimer RJ, Abudu A et al (2003) Endoprosthetic replacement of the proximal humerus. Long-term results. J Bone Joint Surg Br 85:717–722

    CAS  PubMed  Google Scholar 

  12. Funovics PT, Dominkus M (2010) Modular tumor prostheses of the humerus. Orthopade 39:968–979

    Article  CAS  PubMed  Google Scholar 

  13. Enneking W, Dunham W, Gebhardt M et al (1990) A system for the classification of skeletal resections. Chir Organi Mov 75:217–240

    CAS  PubMed  Google Scholar 

  14. Hardes J, Ahrens H, Nottrott M et al (2012) Attachment tube for soft tissue reconstruction after implantation of a mega-endoprosthesis. Oper Orthop Traumatol 24:227–234

    Article  CAS  PubMed  Google Scholar 

  15. Gosheger G, Hardes J, Ahrens H et al (2005) Endoprosthetic replacement of the humerus combined with trapezius and latissimus dorsi transfer: a report of three patients. Arch Orthop Trauma Surg 125:62–65

    Article  CAS  PubMed  Google Scholar 

  16. De Wilde L, Boileau P, Van der Bracht H (2011) Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment? Clin Orthop Relat Res 469:2489–2495

    Article  PubMed Central  PubMed  Google Scholar 

  17. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15:527–540

    Article  PubMed  Google Scholar 

  18. Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg Am Shoulder Elbow Surg 20:146–157

    Article  Google Scholar 

  19. Favard L, Levigne C, Nerot C et al (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469:2469–2475

    Article  PubMed Central  PubMed  Google Scholar 

  20. Enneking WF, Dunham W, Gebhardt MC et al (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246

    PubMed  Google Scholar 

  21. van de Sande MA, Dijkstra PD, Taminiau AH (2011) Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction. Int Orthop 35:1375–1380

    Article  PubMed Central  PubMed  Google Scholar 

  22. Potter BK, Adams SC, Pitcher JD Jr et al (2009) Proximal humerus reconstructions for tumors. Clin Orthop Relat Res 467:1035–1041

    Article  PubMed Central  PubMed  Google Scholar 

  23. Raiss P, Kinkel S, Sauter U et al (2010) Replacement of the proximal humerus with MUTARS tumor endoprostheses. Eur J Surg Oncol 36:371–377

    Article  CAS  PubMed  Google Scholar 

  24. Dieckmann R, Liem D, Gosheger G et al (2013) Evaluation of a reconstruction reverse shoulder for tumour surgery and tribological comparision with an anatomical shoulder arthroplasty. Int Orthop 37:451–456

    Article  PubMed Central  PubMed  Google Scholar 

  25. Scarlat MM (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop 37:843–851

    Article  PubMed Central  PubMed  Google Scholar 

  26. Boileau P, Gonzalez JF, Chuinard C et al (2009) Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg Am 18:600–606

    Article  Google Scholar 

  27. Hsu SHG, Saifi M, Ahmad CS (2011) Reverse total shoulder arthroplasty—biomechanics and rationale. Oper Tech Orthop 21:52–59

    Article  Google Scholar 

  28. Ladermann A, Walch G, Lubbeke A et al (2012) Influence of arm lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg Am 21:336–341

    Article  Google Scholar 

  29. Ladermann A, Williams MD, Melis B et al (2009) Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg Am 18:588–595

    Article  Google Scholar 

  30. Cannon CP, Paraliticci GU, Lin PP (2009) Functional outcome following endoprosthetic reconstruction of the proximal humerus. J Shoulder Elbow Surg Am Shoulder Elbow Surg 18:705–710

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, Germany

    Arne Streitbuerger, Marcel Henrichs, Georg Gosheger, Helmut Ahrens, Markus Nottrott, Wiebke Guder, Ralf Dieckmann & Jendrik Hardes

Authors
  1. Arne Streitbuerger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Henrichs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georg Gosheger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helmut Ahrens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markus Nottrott
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wiebke Guder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ralf Dieckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jendrik Hardes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arne Streitbuerger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Streitbuerger, A., Henrichs, M., Gosheger, G. et al. Improvement of the shoulder function after large segment resection of the proximal humerus with the use of an inverse tumour prosthesis. International Orthopaedics (SICOT) 39, 355–361 (2015). https://doi.org/10.1007/s00264-014-2560-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2560-2

Keywords

Search

Navigation