Reverse Allograft Prosthetic-Composite Versus Endoprosthesis Reconstruction for Massive Proximal Humerus Bone Loss: A Systematic Review and Meta-analysis of Outcomes and Complications.

Autor: Hao KA; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL USA., Gutowski CT; Cooper Medical School of Rowan University, Camden, NJ USA., Bindi VE; College of Medicine, University of Florida, Gainesville, FL USA., Srinivasan RC; The Hand and Upper Extremity Center of San Antonio, San Antonio, TX USA., Wright JO; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL USA., King JJ; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL USA., Wright TW; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL USA., Fedorka CJ; Cooper Bone and Joint Institute, Cooper Medical School of Rowan University, Camden, NJ USA., Schoch BS; Department of Orthopaedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA., Hones KM; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL USA.
Jazyk: angličtina
Zdroj: Indian journal of orthopaedics [Indian J Orthop] 2024 Sep 01; Vol. 58 (10), pp. 1339-1348. Date of Electronic Publication: 2024 Sep 01 (Print Publication: 2024).
DOI: 10.1007/s43465-024-01248-7
Abstrakt: Background: This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.
Methods: Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.
Results: Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation ( P  = .231), external rotation ( P  = .634), ASES score ( P  = .420), Constant score ( P  = .414), MSTS ( P  = .815), SST ( P  = .367), or VAS ( P  = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.
Discussion: Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients' healing capacity and surgeon experience.
Level of Evidence: Level IV; Systematic Review.
Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-024-01248-7.
Competing Interests: Conflict of interestMr. Hao is a paid consultant for LinkBio Corp. Dr. Schoch receives royalties from Exactech, Innomed, and Responsive Arthroscopy. Dr. King is a paid consultant for Exactech, Inc. and LinkBio Corp. Dr. T. Wright is a paid consultant and receives royalties from Exactech, Inc. Dr. Fedorka is a paid consultant for Stryker Corporation. Dr. Srinivasan is a paid consultant for Acumed Exsomed LLC, Turner Imaging Systems and Hinge Health. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
(© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
Databáze: MEDLINE
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