White Alex E, Ponce Robert B, Wrenn Sean P, Healy Ryan J, Khanna Akshay, Brusalis Christopher M, Taylor Samuel A
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Shoulder Elbow Surg. 2025 Jul;34(7):e579-e591. doi: 10.1016/j.jse.2024.09.028. Epub 2024 Nov 22.
Massive proximal humeral bone loss (PHBL) poses a technical challenge during reverse shoulder arthroplasty (RSA). Surgical treatment strategies include allograft-prosthetic composite (APC) reconstructions, endoprostheses, and other reverse shoulder arthroplasty constructs; however, there is a paucity of literature summarizing the outcomes and complications unique to this complex patient population. This study aimed to systematically review the literature to evaluate (1) patient-reported outcome measures, (2) functional outcomes, and (3) complications according to surgical treatment strategy for patients with massive PHBL who undergo primary or revision shoulder arthroplasty.
A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes and complications of reverse shoulder arthroplasty in patients with significant PHBL. Methodological quality was assessed for included studies. Patient-reported outcome measures, radiographic outcomes, and postoperative functional outcomes were collected.
Eleven studies evaluating clinical outcomes and complications of reverse shoulder arthroplasty in the setting of PHBL comprising 277 patients were included for review. The mean age was 66 years (range, 60-79 years). American Shoulder and Elbow Surgeons score, Visual Analog Scale, and range of motion were the most common outcomes collected, and patients exhibited significant improvements in mean scores postoperatively. Of the types of prostheses reported, there were 155 reverse shoulder arthroplasty (RSA) with allograft-prosthetic composite (APC) reconstructions, 48 proximal humeral replacement (PHR) endoprostheses, 41 RSA, 15 custom RSA, and 2 RSA with fibular strut allografts. The overall pooled complication rate was 30.1% (82/272) with revision/reoperation as the most common complication at 21% (57/272). The overall complication rate for RSA-APC reconstructions was 51% (79/155). The overall complication rate for PHR endoprostheses was 64.6% (31/48). Revision/reoperation rates were the most complication for both RSA-APC and PHR endoprostheses with rates of 20% and 31.3%, respectively.
Treatment by APC reconstruction is the most common surgical technique described in the setting of massive PHBL. While shoulder arthroplasty can yield acceptable results for patients with substantial PHBL, such patients are at increased risk for complications and revision surgery.
肱骨近端大量骨丢失（PHBL）在反式肩关节置换术（RSA）中构成技术挑战。手术治疗策略包括同种异体移植-假体复合物（APC）重建、内置假体以及其他反式肩关节置换结构；然而，缺乏文献总结这一复杂患者群体特有的治疗结果和并发症。本研究旨在系统回顾文献，以评估接受初次或翻修肩关节置换术的大量PHBL患者根据手术治疗策略的（1）患者报告的结局指标、（2）功能结局和（3）并发症。
对PubMed/MEDLINE、Embase和Cochrane数据库进行系统回顾，以识别报告严重PHBL患者反式肩关节置换术临床结局和并发症的研究。对纳入研究的方法学质量进行评估。收集患者报告的结局指标、影像学结局和术后功能结局。
纳入11项评估PHBL背景下反式肩关节置换术临床结局和并发症的研究，共277例患者。平均年龄为66岁（范围60 - 79岁）。美国肩肘外科医师评分、视觉模拟量表和活动范围是最常收集的结局指标，患者术后平均评分有显著改善。在所报告的假体类型中，有155例为带同种异体移植-假体复合物（APC）重建的反式肩关节置换术（RSA），48例为肱骨近端置换（PHR）内置假体，41例RSA，15例定制RSA，以及2例带腓骨支撑异体移植的RSA。总体合并并发症发生率为30.1%（82/272），翻修/再次手术是最常见的并发症，发生率为21%（57/272）。RSA-APC重建的总体并发症发生率为51%（79/155）。PHR内置假体的总体并发症发生率为64.6%（31/48）。翻修/再次手术率是RSA-APC和PHR内置假体最常见的并发症，发生率分别为20%和31.3%。
APC重建治疗是大量PHBL背景下描述最多的手术技术。虽然肩关节置换术对大量PHBL患者可产生可接受的结果，但这类患者并发症和翻修手术的风险增加。
