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Bone Tumors and Orthopedics

(P 84) A MULTICENTER COMPARISON OF REVERSE TOTAL SHOULDER ARTHROPLASTY VERSUS HEMIARTHROPLASTY FOR ENDOPROSTHETIC RECONSTRUCTION FOLLOWING ONCOLOGIC RESECTION OF THE PROXIMAL HUMERUS

Objective: The purpose of this study was to compare the complication rate and functional outcome of reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty (HA) endoprosthetic reconstruction (EPR) in patients undergoing proximal humeral resection for primary or metastatic bone tumors.

Methods: Patients undergoing oncologic resection and proximal humerus EPR with rTSA or HA at six institutions between 2010 and 2024 were retrospectively reviewed. In total, 295 patients were included, with 154 (52%) HA and 141 (48%) rTSA. Eighty-six percent (n=121) rTSA were performed by orthopaedic oncologists without shoulder surgeon collaboration. Patient, tumor, and surgical details were collected. Complications and functional outcomes were compared with Fischer exact tests. Median final follow-up was 18.6 months (rTSA) and 12.2 months (HA) (p=0.247).

Results: At final follow up, the reoperation rate was 28% with rTSA and 8% with HA (p < 0.0001). Dislocation was the indication for first reoperation in 18 rTSA (46%) versus 3 HA (2%) (p=0.0004). Acute dislocation occurred in 24 rTSA (17%) and 3 HA (2%) (p < 0.0001), whereas 23 HA (15%) demonstrated chronic dislocation in the form of anterosuperior escape. Humeral aseptic loosening rate was 2% (3% rTSA, 1% HA); glenoid aseptic loosening in rTSA patients was 1%. Fifty-four rTSA (38%) had final forward elevation (FE) > 90 degrees, while only 10 HA (6%) did (p < 0.0001). Conversely, 91 HA (59%) had active FE < 45 degrees compared to only 22 rTSA (16%) (p < 0.0001).

Conclusion: Modular rTSA has significantly improved active FE when compared to HA, but with higher reoperation rates primarily driven by instability.