Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma
(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is peripr...
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MDPI AG
2021-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/15/3424 |
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| author | Sebastian Klingebiel Kristian Nikolaus Schneider Georg Gosheger Thomas Ackmann Maximilian Timme Carolin Rickert Niklas Deventer Christoph Theil |
| author_facet | Sebastian Klingebiel Kristian Nikolaus Schneider Georg Gosheger Thomas Ackmann Maximilian Timme Carolin Rickert Niklas Deventer Christoph Theil |
| author_sort | Sebastian Klingebiel |
| collection | DOAJ |
| description | (1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3–9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23–57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference. |
| first_indexed | 2024-03-10T09:13:00Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T09:13:00Z |
| publishDate | 2021-07-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-7490db050e264315b9884e63bd2d16182023-11-22T05:50:41ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-011015342410.3390/jcm10153424Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with SarcomaSebastian Klingebiel0Kristian Nikolaus Schneider1Georg Gosheger2Thomas Ackmann3Maximilian Timme4Carolin Rickert5Niklas Deventer6Christoph Theil7Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyInstitute for Legal Medicine, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, GermanyDepartment of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, Germany(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3–9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23–57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference.https://www.mdpi.com/2077-0383/10/15/3424sarcomashouldershoulder arthroplastymegaprosthesisaseptic looseningradiotherapy |
| spellingShingle | Sebastian Klingebiel Kristian Nikolaus Schneider Georg Gosheger Thomas Ackmann Maximilian Timme Carolin Rickert Niklas Deventer Christoph Theil Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma Journal of Clinical Medicine sarcoma shoulder shoulder arthroplasty megaprosthesis aseptic loosening radiotherapy |
| title | Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma |
| title_full | Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma |
| title_fullStr | Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma |
| title_full_unstemmed | Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma |
| title_short | Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma |
| title_sort | periprosthetic stress shielding of the humerus after reconstruction with modular shoulder megaprostheses in patients with sarcoma |
| topic | sarcoma shoulder shoulder arthroplasty megaprosthesis aseptic loosening radiotherapy |
| url | https://www.mdpi.com/2077-0383/10/15/3424 |
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