Der Orthopäde

, Volume 46, Issue 12, pp 1022–1027 | Cite as

Large diaphyseal-incorporating allograft prosthetic composites: when, how, and why

Treatment of advanced proximal humeral bone loss
Leitthema

Abstract

Background

Proximal humeral bone loss in shoulder arthroplasty is a complex problem with a heterogeneous presentation. Different etiologies may contribute to varying degrees of severity in bone loss that dictate different treatment approaches.

Objectives

The purpose of this is article is to describe our technique for treatment of proximal humeral bone loss with proximal humeral allograft prosthetic composites (APC) and identify factors that may predict when larger allografts may be necessary.

Materials and methods

Ninety-nine patients were identified that had undergone reverse total shoulder arthroplasty with use of a proximal humeral allograft. Thirty-nine of these had large allografts that involved a significant portion of the diaphysis. Preoperative characteristics were examined to identify factors that may be associated with use of a larger diaphyseal-incorporating allograft.

Results

Well-fixed humeral stems could be treated with short metaphyseal allografts in 55 of 65 (85%) cases. Loose stems required longer diaphyseal-incorporating allografts in 28 of 31 (90%) cases, and these were commonly associated with periprosthetic fractures (n = 10), failed prior APC (n = 6), and infection (n = 5). Noncemented stems required diaphyseal grafts in 75% of cases, compared to cemented stems which required larger grafts in 34% of cases.

Conclusions

Proximal humeral bone loss in the setting of revision shoulder arthroplasty can be successfully managed with a reverse total shoulder and proximal humeral allograft. Larger allografts are frequently required for loose humeral stems, and noncemented stems appear more likely to require larger allografts than cemented stems.

Keywords

Allograft Reoperation Reverse total shoulder arthroplasty Arthroplasty, replacement, shoulder Shoulder prosthesis 

Abbreviations

APC

Allograft prosthetic composites

HA

Hemiarthroplasty

ORIF

Open reduction and internal fixation

RSA

Reverse total shoulder arthroplasty

TSA

Total shoulder arthroplasty

Langstreckige „allograft prosthetic composites“ (APC) mit diaphysärem Anteil: wann, wie und warum

Behandlung fortgeschrittener Knochenverluste im proximalen Humerus

Zusammenfassung

Hintergrund

Knochendefekte stellen in der Schulterendoprothetik ein komplexes Problem mit variationsreichem Erscheinungsbild dar. Die Ursachen sind vielfältig, und die unterschiedlichen Schweregrade an Knochenverlust erfordern zwingend individuelle Behandlungsstrategien.

Ziele

Ziel der Arbeit ist die Darstellung unserer Operationstechnik bei Knochenverlust am proximalem Humerus, bei der bevorzugt proximale Allografts im Verbund mit einer inversen Endoprothese als „allograft prosthetic composites“ (APC) verwendet werden. Ferner sollen Faktoren identifiziert werden, anhand derer sich die Notwendigkeit eines langstreckigen Aufbaus vorhersagen lassen könnte.

Materialien und Methoden

Analysiert wurden 99 Patienten, denen eine inverse Schulterendoprothese unter Verwendung von proximalen Humerus-Allografts implantiert worden war, 39 von ihnen ein langstreckiges Allograft mit diaphysärem Anteil. Die präoperativen Befunde wurden insbesondere im Hinblick auf diese langstreckigen diaphysären Defekte untersucht.

Ergebnisse

Stabil verankerte Humerusschäfte konnten mit kurzen metaphysären Allografts bei 55 von 65 Patienten (85 %) versorgt werden. Bei Schaftlockerungen waren langstreckige Allografts mit diaphysärem Anteil in 28 von 31 Fällen (90 %) erforderlich; dieses Vorgehen war überwiegend bedingt durch periprothetischen Frakturen (n = 10), bei Zustand nach misslungenem APC-Aufbau (n = 6) und durch Infektionen (n = 5). Allografts mit diaphysärem Anteil waren bei unzementierter Schaftverankerung für 75 % der Patienten erforderlich, bei zementierten Schäften dagegen nur für 34 %.

Fazit

Knochendefekte des proximalen Humerus können bei Revisionseingriffen erfolgreich mit inversen Schulterendoprothesen in Kombination mit proximalen Humerus-Allografts behandelt werden. Langstreckige Allografts sind bei Schaftlockerungen häufig erforderlich, wobei dies eher für die zementfreie Fixierung als für zementierte Schäfte gilt.

Schlüsselwörter

Allograft Reoperation Inverse Schulter-Totalendoprothese Schulterarthroplastik  Schulterprothese 

Notes

Compliance with ethical guidelines

Conflict of interest

P.B. McLendon and J.L. Cox declares that they have no competing interests. M.A. Frankle is a paid consultant for DJO Surgical and Cayenne Medical. M.A. Frankle also receives royalties from DJO Surgical.

This article does not contain any studies with human participants or animals performed by any of the authors.

This study was determined to be exempt from review by the Western Institutional Review Board (WIRB).

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Shoulder and Elbow ServiceFlorida Orthopaedic InstituteTampaUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of South FloridaTampaUSA

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