Our Summary

This research paper is about a medical procedure called reverse total shoulder arthroplasty (rTSA), which is a kind of shoulder joint replacement surgery. Recently, doctors have been considering using this surgery to rebuild the top part of the upper arm bone (the proximal humerus) after it’s been damaged by cancer.

The researchers looked at 12 previous studies that reported how patients did after having rTSA for cancer-related reasons. They found that the average patient was 48 years old, that slightly more than half were men, and that most had either a primary cancer in the bone or cancer that had spread from somewhere else.

On average, the doctors had to remove about 12 cm of the upper arm bone during these surgeries. Afterwards, patients generally did fairly well. Their scores on a few different measures of how well their arms were working were mostly around 60-80% of the maximum.

However, about a quarter of the patients did have complications after surgery. The most common problem was instability in the shoulder, and about one in six patients had to have more surgery to fix problems. That said, the artificial joint that was used in the surgery lasted pretty well – it was still working for 89% of the patients after an average of about 4.5 years.

The researchers caution that the studies they looked at weren’t the best quality, and there was a fair bit of variation in the results. Therefore, while rTSA seems like a good option for some patients with cancer in the upper arm bone, we need more high-quality research to be sure about when and how to best use this procedure.

FAQs

  1. What is reverse total shoulder arthroplasty (rTSA) used for in oncologic procedures?
  2. What are the common complications and outcomes of using rTSA for oncologic reconstruction of the proximal humerus?
  3. What is the survival rate of the implant used in rTSA for oncologic reconstruction of the proximal humerus?

Doctor’s Tip

A helpful tip a doctor might give a patient considering shoulder replacement surgery is to carefully follow the post-operative rehabilitation and physical therapy plan to ensure optimal outcomes and minimize the risk of complications. It is also important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for shoulder replacement, specifically reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus, include those with primary malignancies, metastatic disease, or benign tumors affecting the shoulder joint. These patients may have undergone oncologic resection of the proximal humerus and require reconstruction to restore function and alleviate pain. The mean age of patients undergoing this procedure is 48 years, with a slightly higher percentage of male patients. The most common complication associated with this procedure is shoulder instability, and revisions may be necessary in some cases. Overall, higher-quality evidence is needed to better guide decision-making for appropriate implant utilization in patients undergoing oncologic resection of the proximal humerus.

Timeline

Timeline of patient experience before and after shoulder replacement:

Before shoulder replacement:

  1. Patient experiences chronic shoulder pain and limited range of motion.
  2. Patient consults with an orthopedic surgeon who recommends shoulder replacement surgery.
  3. Preoperative evaluations and tests are conducted to assess the patient’s overall health and suitability for surgery.
  4. Patient undergoes preoperative physical therapy to strengthen the shoulder muscles and prepare for surgery.

After shoulder replacement:

  1. Patient undergoes shoulder replacement surgery, which typically takes 1-2 hours.
  2. Patient stays in the hospital for 1-3 days for monitoring and rehabilitation.
  3. Patient starts postoperative physical therapy to regain shoulder strength and range of motion.
  4. Patient may experience temporary pain and discomfort after surgery, which is managed with pain medication.
  5. Over the course of several months, patient gradually improves shoulder function and resumes normal activities.
  6. Follow-up appointments are scheduled with the orthopedic surgeon to monitor progress and address any concerns.
  7. Patient enjoys improved shoulder function and quality of life after successful shoulder replacement surgery.

What to Ask Your Doctor

  1. What are the benefits of undergoing a reverse total shoulder arthroplasty (rTSA) for oncologic reconstruction of the proximal humerus?
  2. What are the potential risks and complications associated with rTSA for oncologic reconstruction?
  3. How long is the recovery process after undergoing rTSA for oncologic reconstruction?
  4. What is the expected outcome in terms of function and pain relief after undergoing rTSA for oncologic reconstruction?
  5. Are there any specific restrictions or limitations in activities that I should be aware of after the surgery?
  6. How long do the implants typically last in patients undergoing oncologic rTSA?
  7. How frequently will follow-up appointments be needed after the surgery?
  8. Are there any alternative treatment options for oncologic reconstruction of the proximal humerus that I should consider?
  9. What is the success rate of rTSA for oncologic reconstruction in patients with similar characteristics and conditions as mine?
  10. What are the qualifications and experience of the surgeon who will be performing the rTSA procedure for oncologic reconstruction?

Reference

Authors: Ferlauto HR, Wickman JR, Lazarides AL, Hendren S, Visgauss JD, Brigman BE, Anakwenze OA, Klifto CS, Eward WC. Journal: J Shoulder Elbow Surg. 2021 Nov;30(11):e647-e658. doi: 10.1016/j.jse.2021.06.004. Epub 2021 Jul 15. PMID: 34273534