Management of large proximal humeral bone defects at the time of revision shoulder arthroplasty can be challenging. Surgeons need to restore humeral length, provide adequate support for the revision implant, optimize deltoid tension, and provide soft tissue attachment sites to reconstruct a stable and functional shoulder. Although proximal humeral bone loss may also be encountered in complex primary cases (such as after resection of malignancies and after trauma), the focus of this chapter is on revision surgery. Options for the management of substantial proximal humerus bone loss include osteoarticular allografts, allograft-prosthetic composites (APCs), and proximal humeral prostheses with large metal replacement humeral bodies. Osteoarticular allografts are seldom used in the setting of revision surgery. The use of modular segmental metal proximal humeral prostheses is a viable option for relatively shorter defects and in situations when the potential for graft-to-host union is hindered, such as with that of radiation or chemotherapy. APCs are particularly appealing for longer defects, especially when soft tissue reattachment is considered important. Nonetheless, patients undergoing revision arthroplasty in the setting of proximal humeral bone loss are at an increased risk for poor range of motion, worse functional outcomes, dislocation, mechanical failure, and other complications when compared to cohorts of patients with preserved native proximal bone and soft tissue attachments; patients should be counseled accordingly.
Proximal humeral bone loss Reverse shoulder arthroplasty Allograft-prosthetic composite Modular segmental metal proximal humerus prosthesis
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