Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection
Abstract Background Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hinde...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12957-023-03173-9 |
| _version_ | 1797452428429230080 |
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| author | Jan Lesensky Ana C. Belzarena Matej Daniel |
| author_facet | Jan Lesensky Ana C. Belzarena Matej Daniel |
| author_sort | Jan Lesensky |
| collection | DOAJ |
| description | Abstract Background Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hindering also function of the elbow and hand, whereas constrained shoulder reconstructions suffer from early aseptic loosening of the glenoid component due to bone overload. The purpose of this study was to develop a constrained implant suitable for extra-articular resection with loss of function in deltoid and rotator cuff, which would provide both stability and passive motion, whilst also decreasing the risk of aseptic loosening of the glenoid component. Methods In cooperation with Czech Technical University in Prague, we devised an implant consisting of two constrained joints in series connected by a dumbbell piece. The biomechanical analysis showed a reduction of load transfer to the glenoid component with a torque of 8.6 Nm capable of generating an 865-N pulling force on bone screw to just 0.07 Nm, hence shielding the glenoid component from undesired forces and decreasing the risk of aseptic loosening. Three patients with extra-articular resection with a total loss of function of both rotator cuff and deltoid muscle received this type of reconstruction. The average follow-up was 16 months. Results The surgical technique is straightforward. The surgery took 175 min on average with average blood loss of 516 ml. There were no surgical- or implant-related complications. All three patients were pain-free and had a stable shoulder joint after the reconstruction. All had fully functional elbow, wrist, and hand joints. The average Musculoskeletal Tumor Society (MSTS) score was 21/30 (70%). All patients were pleased with the results. Conclusion The presented innovative implant design has demonstrated to be a promising alternative for reconstruction in these challenging cases. |
| first_indexed | 2024-03-09T15:08:38Z |
| format | Article |
| id | doaj.art-343d378ab7b44aed9926481f38fb63e6 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-03-09T15:08:38Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-343d378ab7b44aed9926481f38fb63e62023-11-26T13:31:32ZengBMCWorld Journal of Surgical Oncology1477-78192023-09-012111910.1186/s12957-023-03173-9Reconstruction with a double-constrained implant design after complex shoulder extra-articular resectionJan Lesensky0Ana C. Belzarena1Matej Daniel2Department of Orthopaedics, First Medical Faculty, University Hospital Na Bulovce, Charles UniversityDepartment of Orthopedic Surgery, University of MissouriDepartment of Mechanics, Biomechanics, and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in PragueAbstract Background Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hindering also function of the elbow and hand, whereas constrained shoulder reconstructions suffer from early aseptic loosening of the glenoid component due to bone overload. The purpose of this study was to develop a constrained implant suitable for extra-articular resection with loss of function in deltoid and rotator cuff, which would provide both stability and passive motion, whilst also decreasing the risk of aseptic loosening of the glenoid component. Methods In cooperation with Czech Technical University in Prague, we devised an implant consisting of two constrained joints in series connected by a dumbbell piece. The biomechanical analysis showed a reduction of load transfer to the glenoid component with a torque of 8.6 Nm capable of generating an 865-N pulling force on bone screw to just 0.07 Nm, hence shielding the glenoid component from undesired forces and decreasing the risk of aseptic loosening. Three patients with extra-articular resection with a total loss of function of both rotator cuff and deltoid muscle received this type of reconstruction. The average follow-up was 16 months. Results The surgical technique is straightforward. The surgery took 175 min on average with average blood loss of 516 ml. There were no surgical- or implant-related complications. All three patients were pain-free and had a stable shoulder joint after the reconstruction. All had fully functional elbow, wrist, and hand joints. The average Musculoskeletal Tumor Society (MSTS) score was 21/30 (70%). All patients were pleased with the results. Conclusion The presented innovative implant design has demonstrated to be a promising alternative for reconstruction in these challenging cases.https://doi.org/10.1186/s12957-023-03173-9Shoulder reconstructionTumorSarcomaExtra-articular resection |
| spellingShingle | Jan Lesensky Ana C. Belzarena Matej Daniel Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection World Journal of Surgical Oncology Shoulder reconstruction Tumor Sarcoma Extra-articular resection |
| title | Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection |
| title_full | Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection |
| title_fullStr | Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection |
| title_full_unstemmed | Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection |
| title_short | Reconstruction with a double-constrained implant design after complex shoulder extra-articular resection |
| title_sort | reconstruction with a double constrained implant design after complex shoulder extra articular resection |
| topic | Shoulder reconstruction Tumor Sarcoma Extra-articular resection |
| url | https://doi.org/10.1186/s12957-023-03173-9 |
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