Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jianxiong ¹ , BI Jingyou ¹ , ZHAO Xuelin ¹ , YAO Peng ^1,2 , LIU Yatao ¹ ,  BI Wenzhi ¹

1. Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Xinxiang Detachment of Henan General Corps of Chinese People’s Armed Police, Xinxiang Henan, 453000, P.R.China;

Corresponding?author：

BI Wenzhi, Email: biwenzhi@sina.com

Keywords：

Scapular tumor; total scapular arthroplasty; shoulder joint; joint reconstruction

DOI：

10.7507/1002-1892.201907016

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Objective To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.Methods A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing’s sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph.Results Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively.Conclusion Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.

Citation： LI Jianxiong, BI Jingyou, ZHAO Xuelin, YAO Peng, LIU Yatao, BI Wenzhi. Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 179-183. doi: 10.7507/1002-1892.201907016 Copy

1.	Mayil Vahanan N, Mohanlal P, Bose JC, et al. The functional and oncological results after scapulectomy for scapular tumours: 2-16-year results. Int Orthop, 2007, 31(6): 831-836.
2.	Yang Q, Li J, Yang Z, et al. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. Int Orthop, 2010, 34(6): 869-875.
3.	Mavrogenis AF, Mastorakos DP, Triantafyllopoulos G, et al. Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing’s sarcoma. J Surgical Oncol, 2009, 100(7): 611-615.
4.	Nakamura S, Kusuzaki K, Murata H, et al. Clinical outcome of total scapulectomy in 10 patients with primary malignant bone and soft-tissue tumors. J Surg Oncol, 1999, 72(3): 130-135.
5.	Marcove RC, Lewis MM, Huvos AG. En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Related Res, 1977, (124): 219-228.
6.	Xu SF, Yu XC, Xu M, et al. Functional results and emotional acceptance after scapulectomy for malignant shoulder tumors. Orthop Surg, 2016, 8(2): 186-195.
7.	Capanna R, Totti F, Van Der Geest IC, et al. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results. J Shoulder Elbow Surg, 2015, 24(8): e203-e211.
8.	Mnaymneh WA, Temple HT, Malinin TI. Allograft reconstruction after resection of malignant tumors of the scapula. Clin Orthop Relat Res, 2002, (405): 223-229.
9.	Tang X, Guo W, Yang R, et al. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg, 2011, 20(7): 1163-1169.
10.	Wittig JC, Bickels J, Wodajo F, et al. Constrained total scapula reconstruction after resection of a high-grade sarcoma. Clin Orthop Relat Res, 2002, (397): 143-155.
11.	Linberg BE. Interscapulo-thoracic resection for malignant tumors of the shoulder joint region. 1928. Clin Orthop Relat Res, 1999, (358): 3-7.
12.	Ham SJ, Hoekstra HJ, Eisma WH, et al. The Tikhoff-Linberg procedure in the treatment of sarcomas of the shoulder girdle. J Surg Oncol, 2010, 53(2): 71-77.
13.	Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res, 1980, (153): 106-120.
14.	Han G, Wang Y, Bi WZ, et al. Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy. Med Oncol, 2012, 29(2): 1347-1353.
15.	Loh AH, Wu H, Bahrami A, et al. Influence of bony resection margins and surgicopathological factors on outcomes in limb-sparing surgery for extremity osteosarcoma. Pediatr Blood Cancer, 2015, 62(2): 246-251.
16.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
17.	Chandrasekar CR, Mohammed R, Grimer RJ. Extracorporeally irradiated scapula as autograft in tumor surgery. J Shoulder Elbow Surg, 2009, 18(3): e28-e32.
18.	Scalise JJ, Iannotti JP. Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res, 2008, 466(1): 139-145.
19.	Uozaki H, Ishida T, Kakiuchi C, et al. Expression of heat shock proteins in osteosarcoma and its relationship to prognosis. Pathol Res Pract, 2000, 196(10): 665-673.
20.	Trieb K, Lechleitner T, Lang S, et al. Heat shock protein 72 expression in osteosarcomas correlates with good response to neoadjuvant chemotherapy. Hum Pathol, 1998, 29(10): 1050-1055.
21.	Pritsch T, Bickels J, Wu CC, et al. Is scapular endoprosthesis functionally superior to humeral suspension? Clin Orthop Relat Res, 2007, (456): 188-195.
22.	Wang BC, Wu Q, Zhang Z, et al. Reconstruction with constrained scapular prosthesis after total scapulectomy for scapular malignant tumor. J Surg Oncol, 2018, 118(1): 177-183.
23.	Savvidou OD, Zampeli F, Georgopoulos G, et al. Total scapulectomy and shoulder reconstruction using a scapular prosthesis and constrained reverse shoulder arthroplasty. Orthopedics, 2018, 41(6): e888-e893.
24.	Schwab JH, Athanasian EA, Morris CD, et al. Function correlates with deltoid preservation in patients having scapular replacement. Clin Orthop Relat Res, 2006, (452): 225-230.

1. Mayil Vahanan N, Mohanlal P, Bose JC, et al. The functional and oncological results after scapulectomy for scapular tumours: 2-16-year results. Int Orthop, 2007, 31(6): 831-836.
2. Yang Q, Li J, Yang Z, et al. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. Int Orthop, 2010, 34(6): 869-875.
3. Mavrogenis AF, Mastorakos DP, Triantafyllopoulos G, et al. Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing’s sarcoma. J Surgical Oncol, 2009, 100(7): 611-615.
4. Nakamura S, Kusuzaki K, Murata H, et al. Clinical outcome of total scapulectomy in 10 patients with primary malignant bone and soft-tissue tumors. J Surg Oncol, 1999, 72(3): 130-135.
5. Marcove RC, Lewis MM, Huvos AG. En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Related Res, 1977, (124): 219-228.
6. Xu SF, Yu XC, Xu M, et al. Functional results and emotional acceptance after scapulectomy for malignant shoulder tumors. Orthop Surg, 2016, 8(2): 186-195.
7. Capanna R, Totti F, Van Der Geest IC, et al. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results. J Shoulder Elbow Surg, 2015, 24(8): e203-e211.
8. Mnaymneh WA, Temple HT, Malinin TI. Allograft reconstruction after resection of malignant tumors of the scapula. Clin Orthop Relat Res, 2002, (405): 223-229.
9. Tang X, Guo W, Yang R, et al. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg, 2011, 20(7): 1163-1169.
10. Wittig JC, Bickels J, Wodajo F, et al. Constrained total scapula reconstruction after resection of a high-grade sarcoma. Clin Orthop Relat Res, 2002, (397): 143-155.
11. Linberg BE. Interscapulo-thoracic resection for malignant tumors of the shoulder joint region. 1928. Clin Orthop Relat Res, 1999, (358): 3-7.
12. Ham SJ, Hoekstra HJ, Eisma WH, et al. The Tikhoff-Linberg procedure in the treatment of sarcomas of the shoulder girdle. J Surg Oncol, 2010, 53(2): 71-77.
13. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res, 1980, (153): 106-120.
14. Han G, Wang Y, Bi WZ, et al. Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy. Med Oncol, 2012, 29(2): 1347-1353.
15. Loh AH, Wu H, Bahrami A, et al. Influence of bony resection margins and surgicopathological factors on outcomes in limb-sparing surgery for extremity osteosarcoma. Pediatr Blood Cancer, 2015, 62(2): 246-251.
16. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
17. Chandrasekar CR, Mohammed R, Grimer RJ. Extracorporeally irradiated scapula as autograft in tumor surgery. J Shoulder Elbow Surg, 2009, 18(3): e28-e32.
18. Scalise JJ, Iannotti JP. Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res, 2008, 466(1): 139-145.
19. Uozaki H, Ishida T, Kakiuchi C, et al. Expression of heat shock proteins in osteosarcoma and its relationship to prognosis. Pathol Res Pract, 2000, 196(10): 665-673.
20. Trieb K, Lechleitner T, Lang S, et al. Heat shock protein 72 expression in osteosarcomas correlates with good response to neoadjuvant chemotherapy. Hum Pathol, 1998, 29(10): 1050-1055.
21. Pritsch T, Bickels J, Wu CC, et al. Is scapular endoprosthesis functionally superior to humeral suspension? Clin Orthop Relat Res, 2007, (456): 188-195.
22. Wang BC, Wu Q, Zhang Z, et al. Reconstruction with constrained scapular prosthesis after total scapulectomy for scapular malignant tumor. J Surg Oncol, 2018, 118(1): 177-183.
23. Savvidou OD, Zampeli F, Georgopoulos G, et al. Total scapulectomy and shoulder reconstruction using a scapular prosthesis and constrained reverse shoulder arthroplasty. Orthopedics, 2018, 41(6): e888-e893.
24. Schwab JH, Athanasian EA, Morris CD, et al. Function correlates with deltoid preservation in patients having scapular replacement. Clin Orthop Relat Res, 2006, (452): 225-230.

Chinese Journal of Reparative and Reconstructive Surgery

Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors

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