Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

CONSTRAINED (ROTATOR CUFF SUBSTITUTING) TOTAL SCAPULA PROSTHESIS: “ANATOMIC” APPROACH FOR RECONSTRUCTING THE SHOULDER GIRDLE FOLLOWING HIGH-GRADE SARCOMA RESECTION
James C Wittig¹, Jacob Bickels², Felasfa Wodajo¹, Kristen L. Kellar-Graney¹, Martin M Malawer¹
¹Division of Orthopedic Oncology Washington Cancer Institute Washington Hospital Center, ²National Unit of Orthopedic Oncology Tel-Aviv Sourasky Medical Center

OBJECTIVE: High-grade sarcomas arising from the scapula or periscapular soft tissues have traditionally been treated with either a total scapulectomy or a wide, en-bloc, extraarticular scapular resection, termed the “Tikhoff-Linberg” resection. The major challenge following such resections is to restore shoulder girdle stability while preserving a functional hand and elbow.

METHODS: This report describes three patients who underwent an extraarticular, total scapula resection (modified Tikhoff-Linberg) for a high-grade sarcoma. Each patient was reconstructed with a constrained (rotator cuff substituting) total scapula prosthesis in an effort to optimally restore the normal muscle force couples of both glenohumeral and scapulothoracic mechanisms.

RESULTS: At latest follow-up, the MSTS functional score was 24-27/30 (80%-90%). All patients had a stable, painless shoulder and functional hand and elbow. Glenohumeral rotation below shoulder level, shoulder extension and adduction were preserved. Protraction, retraction, elevation and abduction of the scapula were restored and participated in active shoulder motion and upper extremity stabilization. There were no complications.

CONCLUSION: Total scapula reconstruction with a constrained total scapula prosthesis is a safe and reliable method for reconstructing the shoulder girdle following resection of select high- grade sarcomas. This report emphasizes the clinical indications, prosthetic design, surgical technique and early functional results.