Alloprosthetic Composite Reconstruction Using the Reverse Shoulder Arthroplasty

摘要

Surgical treatment of a failed total shoulder arthroplasty is difficult, especially with proximal humerus bone stock and concomitant loss of the rotator cuff. This situation can arise from a variety of causes such as infection, trauma, sequela of multiple revisions, and/or periprosthetic fractures. With the combined absence of proximal bone and rotator cuff, options for successful surgical reconstruction become limited. We developed a reliable technique that uses the reverse humeral prosthesis with a femoral shaft allograft in an alloprosthetic composite to address the loss of the rotator cuff as well as a deficient proximal humerus. A long-stemmed reverse prosthesis is cemented into a femoral allograft and the composite is then cemented into the remaining distal humerus. Fixation is augmented with a plate and/or bone growth modulators. We specifically preserve the deltoid attachment and any associated bone, and reattach them to the alloprosthetic composite. In situations where the deltoid insertion is compromised, we reconstruct it by suture reattachment. This step is critical and provides stability and function for the reverse prosthesis. This technique allows for reconstruction of the shoulder and permits improved shoulder function in an otherwise difficult situation.