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

IF 1.1 4区医学 Q3 ORTHOPEDICS

Indian Journal of Orthopaedics Pub Date : 2024-09-01 DOI:10.1007/s43465-024-01248-7

Kevin A. Hao, Caroline T. Gutowski, Victoria E. Bindi, Ramesh C. Srinivasan, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Catherine J. Fedorka, Bradley S. Schoch, Keegan M. Hones

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引用次数: 0

Abstract

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.

Abstract Image

查看原文本刊更多论文

针对肱骨近端大块骨质缺失的反向同种异体假体复合重建与内假体重建：疗效与并发症的系统回顾与 Meta 分析

背景本系统综述和荟萃分析旨在比较反向同种异体移植-假体复合体（APC）与反向假体重建肱骨近端后的临床疗效。方法根据PRISMA指南，我们查询了PubMed/MEDLINE、Embase、Web of Science和Cochrane数据库，以确定报道因肿瘤、骨折或关节成形术失败导致大量骨质流失而进行反向APC或反向假体重建肱骨近端后临床疗效的文章。我们比较了术后活动范围、结果评分以及并发症和翻修手术的发生率。结果在 259 篇文章中，共纳入了 18 篇文章（267 篇 APC，260 篇内假体）。在术后向前抬高（P = .231）、外旋（P = .634）、ASES 评分（P = .420）、Constant 评分（P = .414）、MSTS（P = .815）、SST（P = .367）或 VAS（P = .714）方面，APC 和内假体组间无明显差异。APC队列的并发症发生率为15%（31/213），内假体队列的并发症发生率为19%（27/144）。APC队列的翻修手术率为12%，内假体队列的翻修手术率为7%。APC特异性并发症包括10%的APC非愈合/骨性愈合/吸收率和6%的APC骨折/碎裂率。讨论反向APC和假体内固定是肱骨近端重建的合理选择。APC具有额外的并发症风险，需要对患者的愈合能力和外科医生的经验进行评估。

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来源期刊

Indian Journal of Orthopaedics ORTHOPEDICS-

CiteScore

1.80

自引率

0.00%

发文量

185

审稿时长

9 months

期刊介绍： IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.