title: Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections.
abstract: BACKGROUND
  Proximal humerus reconstructions after resection of tumors are challenging. Early success of the reverse shoulder arthroplasty for reconstructions has recently been reported. The reverse allograft-prosthetic composite offers the advantage of improved glenohumeral stability compared with hemiarthroplasty for proximal humeral reconstructions as it uses the deltoid for stability.
  
  
  METHODS
  This article describes the technique for treating proximal humeral tumors, including preoperative planning, biopsy principles, resection pearls, soft tissue tensioning, and specifics about reconstruction using the reverse allograft-prosthetic composite. Two cases are presented along with the functional outcomes with use of this technique. Biomechanical considerations during reconstruction are reviewed, including techniques to improve the deltoid compression force.
  
  
  RESULTS
  Reported instability rates are less with reverse shoulder arthroplasty reconstruction as opposed to hemiarthroplasty or total shoulder arthroplasty reconstructions of tumor resections. Reported functional outcomes are promising for the reverse allograft-prosthetic composite reconstructions, although complications are reported.
  
  
  CONCLUSIONS
  Reverse allograft-prosthetic composites are a promising option for proximal humeral reconstructions, although nonunion of the allograft-host bone junction continues to be a challenge for this technique.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: King
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA.
authors.forename: Lukas M
authors.initials: LM
authors.lastname: Nystrom
authors.affiliation: Emory Orthopaedics and Spine Center, Atlanta, GA, USA.
authors.forename: Nickolas B
authors.initials: NB
authors.lastname: Reimer
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: C Parker
authors.initials: CP
authors.lastname: Gibbs
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Scarborough
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA. Electronic address: wrightw@ortho.ufl.edu.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
mesh_terms: D000328:Adult; D064591:Allografts; D019643:Arthroplasty, Replacement / Q000295:instrumentation / Q000379:methods*; D001696:Biomechanical Phenomena; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D002813:Chondrosarcoma / Q000601:surgery*; D057645:Deltoid Muscle / Q000601:surgery; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D010347:Patient Care Planning; D011474:Prosthesis Design; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: Reverse total shoulder arthroplasty; allograft-prosthetic composite; glenohumeral joint; proximal humerus reconstruction; tumor resections