Combination of Reverse Shoulder Prosthesis, Elbow Prosthesis, and Polyetheretherketone: A Modified Total Humeral Replacement for Osteosarcoma Humerus Treatment

Total humeral replacement is a complex surgery that requires many challenges to overcome such as the weight of the implant material and the shoulder function due to extensive resection of the rotator cuff. Improvements in implants material that is lighter than usual can lead to higher surgery success rates. We present a patient who was diagnosed with osteosarcoma of the right humerus. The patient received 2 cycles of MAP chemotherapy (included: doxorubicin, cisplatin, and methotrexate) before surgery. He underwent radical resection of osteosarcoma and total humerus replacement with a modified total humeral material. The purpose of this improvement was to reduce the implant’s weight and to improve postoperative recovery. Six months after the surgery, the weight-bearing ability of the patient’s shoulder within a wide range of movement has restored; the shoulder, elbow, and hand can move in a controlled way. Despite the short postoperative follow-up time, the improvement in the modified technique has brought many positive results. Total humerus replacement, which combines the reverse shoulder prosthesis, elbow prosthesis, and polyetheretherketone, is an appropriate solution for patients with osteosarcoma of the humerus instead of custom-made humerus megaprosthesis.

Artroplastia Reversa em um Caso de Reabordagem de Cisto Ósseo em Úmero Proximal

Os cistos ósseos simples são, em regra, assintomáticos e encontrados incidentalmente, embora possam causar dor, edema, rigidez da articulação adjacente ou estarem associados a um quadro de fratura patológica. A curetagem é o modo mais comum de tratamento. O defeito ósseo após curetagem deve ser preenchido com enxertos ósseos ou substitutos, como hidroxiapatita, fosfato tricálcico e cimento. Entretanto, a falha no tratamento pode ser devastadora para o ombro, em decorrência da perda biomecânica da área. Assim, a reconstrução do úmero proximal, após a ressecção do cisto, é um grande desafio para o cirurgião ortopédico. Este caso relata a colocação de uma prótese reversa de ombro (PRO), realizada após a falha do tratamento de um cisto ósseo simples, como uma solução eficiente para a reparação do problema. Simple bone cyst are commonly asymptomatic and incidentally found, although they can cause pain, edema, stiffness of the adjacent joint or be associated with a pathological fracture. Curettage is the most common way of treating simple bone cysts. The bone defect after curettage must be filled with bone grafts or substitutes such as hydroxyapatite, tricalcium phosphate and cement. However, treatment failure can be devastating for the shoulder, due to the biomechanical loss of the area. Thus, the reconstruction of the proximal humerus after resection of the cyst is a major challenge for the orthopedic surgeon. This case reports the placement of a reverse shoulder prosthesis (PRO), performed after the failure of the treatment of a simple bone cyst, as an efficient solution to the problems related to the failure of treatment for the simple bone cyst.