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High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections

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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.

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References

  1. O'Connor MI, Sim FH, Chao EY (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78:1872–1888

    Article  CAS  Google Scholar 

  2. Probyn LJ, Wunder JS, Bell RS, Griffin AM, Davis AM (1998) A comparison of outcome of osteoarticular allograft reconstruction and shoulder arthrodesis following resection of primary tumours of the proximal humerus. Sarcoma 2:163–170. https://doi.org/10.1080/13577149877920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Malawer MM, Sugarbaker PH, Lampert M, Baker AR, Gerber NL (1985) The Tikhoff-Linberg procedure: report of ten patients and presentation of a modified technique for tumors of the proximal humerus. Surgery 97:518–528

    CAS  PubMed  Google Scholar 

  4. Frassica FJ, Sim FH, Chao EY (1987) Primary malignant bone tumors of the shoulder girdle: surgical technique of resection and reconstruction. Am Surg 53:264–269

    CAS  PubMed  Google Scholar 

  5. Ham SJ, Hoekstra HJ, Eisma WH, Schraffordt Koops H, Oldhoff J (1993) The Tikhoff-Linberg procedure in the treatment of sarcomas of the shoulder girdle. J Surg Oncol 53:71–77

    Article  CAS  Google Scholar 

  6. Yang Q, Li J, Yang Z, Li X, Li Z (2010) Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. Int Orthop 34:869–875. https://doi.org/10.1007/s00264-009-0857-3

    Article  PubMed  Google Scholar 

  7. Wittig JC, Bickels J, Wodajo F, Kellar-Graney KL, Malawer MM (2002) Constrained total scapula reconstruction after resection of a high-grade sarcoma. Clin Orthop Relat Res 143–155

  8. Damron TA, Rock MG, O'Connor MI, Johnson M, An KN, Pritchard DJ, Sim FH (1998) Functional laboratory assessment after oncologic shoulder joint resections. Clin Orthop Relat Res 124–134

  9. Angelini A, Mavrogenis AF, Trovarelli G, Pala E, Arbelaez P, Casanova J, Berizzi A, Ruggieri P (2017) Extra-articular shoulder resections: outcomes of 54 patients. J Shoulder Elb Surg 26:e337–e345. https://doi.org/10.1016/j.jse.2017.04.019

    Article  Google Scholar 

  10. Voggenreiter G, Assenmacher S, Schmit-Neuerburg KP (1999) Tikhoff-Linberg procedure for bone and soft tissue tumors of the shoulder girdle. Arch Surg 134:252–257. https://doi.org/10.1001/archsurg.134.3.252

    Article  CAS  PubMed  Google Scholar 

  11. Capanna R, van Horn JR, Biagini R, Ruggieri P, Ferruzzi A, Campanacci M (1990) The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical “extensive” technique versus a modified “transglenoid” resection. Arch Orthop Trauma Surg 109:63–67. https://doi.org/10.1007/bf00439380

    Article  CAS  PubMed  Google Scholar 

  12. Tsuda Y, Fujiwara T, Evans S, Kaneuchi Y, Abudu A (2020) Extra-articular resection of shoulder joint for bone sarcomas: oncologic and limb-salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation. J Surg Oncol 121:612–619. https://doi.org/10.1002/jso.25838

    Article  PubMed  Google Scholar 

  13. Frassica FJ, Chao EY, Shives TC, Sim FH (1991) Resection of malignant bone tumors about the shoulder. A preliminary report of reconstruction with a new modular spacer. Clin Orthop Relat Res 57–64

  14. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93:418–429. https://doi.org/10.2106/JBJS.J.00834

    Article  PubMed  Google Scholar 

  15. Beaton D, Richards RR (1998) Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elb Surg 7:565–572

    Article  CAS  Google Scholar 

  16. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 241–246

  17. Pritsch T, Bickels J, Wu CC, Squires MH, Malawer MM (2007) Is scapular endoprosthesis functionally superior to humeral suspension? Clin Orthop Relat Res 456:188–195. https://doi.org/10.1097/01.blo.0000238840.26423.b6

    Article  PubMed  Google Scholar 

  18. Huiskes R, Weinans H, van Rietbergen B (1992) The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Relat Res 124–134

  19. Sumner DR, Galante JO (1992) Determinants of stress shielding: design versus materials versus interface. Clin Orthop Relat Res 202–212

  20. Nagels J, Stokdijk M, Rozing PM (2003) Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elb Surg 12:35–39. https://doi.org/10.1067/mse.2003.22

    Article  Google Scholar 

  21. Chao EY, Fuchs B, Rowland CM, Ilstrup DM, Pritchard DJ, Sim FH (2004) Long-term results of segmental prosthesis fixation by extracortical bone-bridging and ingrowth. J Bone Joint Surg Am 86:948–955. https://doi.org/10.2106/00004623-200405000-00010

    Article  PubMed  Google Scholar 

  22. Marcove RC, Lewis MM, Huvos AG (1977) En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Relat Res 219–228

  23. Whitehill R, Wanebo HJ, Mabie KN, Schildwachter T, Rosenberger R (1982) Reconstruction after the Tikhoff-Linberg procedure. Arch Surg 117:1248–1249. https://doi.org/10.1001/archsurg.1982.01380330102027

    Article  CAS  PubMed  Google Scholar 

  24. Fujibuchi T, Matsumoto S, Shimoji T, Ae K, Tanizawa T, Gokita T, Hayakawa K (2015) New endoprosthesis suspension method with polypropylene monofilament knitted mesh after resection of bone tumors in proximal humerus. J Shoulder Elb Surg 24:882–888. https://doi.org/10.1016/j.jse.2014.10.011

    Article  Google Scholar 

  25. Wang B, Wu Q, Liu J, Yang S, Shao Z (2015) Endoprosthetic reconstruction of the proximal humerus after tumour resection with polypropylene mesh. Int Orthop 39:501–506. https://doi.org/10.1007/s00264-014-2597-2

    Article  CAS  PubMed  Google Scholar 

  26. Marulanda GA, Henderson E, Cheong D, Letson GD (2010) Proximal and total humerus reconstruction with the use of an aortograft mesh. Clin Orthop Relat Res 468:2896–2903. https://doi.org/10.1007/s11999-010-1418-1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W (2001) Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res:264–271. https://doi.org/10.1097/00003086-200112000-00030

  28. Masterson EL, Ferracini R, Griffin AM, Wunder JS, Bell RS (1998) Capsular replacement with synthetic mesh: effectiveness in preventing postoperative dislocation after wide resection of proximal femoral tumors and prosthetic reconstruction. J Arthroplast 13:860–866. https://doi.org/10.1016/s0883-5403(98)90190-5

    Article  CAS  Google Scholar 

  29. Patt HH (1967) Marlex mesh grafts in inguinal hernia repair. Arch Surg 94:734–736. https://doi.org/10.1001/archsurg.1967.01330110150020

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Adam J. Tagliero, Brandon R. Bukowski, Peter S. Rose, Mark E. Morrey, Bassem T. Elhassan, Jonathan D. Barlow, Joaquin Sanchez-Sotelo & Matthew T. Houdek

  2. Department of Orthopedic Surgery, Emory University, 59 Executive Park, Suite 2000, Atlanta, GA, 30029, USA

    Eric R. Wagner

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  1. Adam J. Tagliero
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  2. Brandon R. Bukowski
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Correspondence to Matthew T. Houdek.

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One of the authors (JSS) is a paid consultant and receives royalties from Stryker Orthopedics. The authors declare that there are no conflicts of interest.

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Tagliero, A.J., Bukowski, B.R., Rose, P.S. et al. High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections. International Orthopaedics (SICOT) 44, 2449–2455 (2020). https://doi.org/10.1007/s00264-020-04576-z

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  • DOI: https://doi.org/10.1007/s00264-020-04576-z

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