Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review

J Shoulder Elbow Surg. 2021 Nov;30(11):e647-e658. doi: 10.1016/j.jse.2021.06.004. Epub 2021 Jul 15.


Background: In recent years, there has been growing interest in the use of reverse total shoulder arthroplasty (rTSA) for reconstruction of the proximal humerus after oncologic resection. However, the indications and outcomes of oncologic rTSA remain unclear.

Methods: We conducted a systematic review to identify studies that reported outcomes of patients who underwent rTSA for oncologic reconstruction of the proximal humerus. Extracted data included demographic characteristics, indications, operative techniques, outcomes, and complications. Weighted means were calculated according to sample size.

Results: Twelve studies were included, containing 194 patients who underwent rTSA for oncologic reconstruction of the proximal humerus. The mean patient age was 48 years, and 52% of patients were male. Primary malignancies were present in 55% of patients; metastatic disease, 30%; and benign tumors, 9%. The mean humeral resection length was 12 cm. The mean postoperative Musculoskeletal Tumor Society score was 78%; Constant score, 60; and Toronto Extremity Salvage Score, 77%. The mean complication rate was 28%, with shoulder instability accounting for 63% of complications. Revisions were performed in 16% of patients, and the mean implant survival rate was 89% at a mean follow-up across studies of 53 months.

Conclusions: Although the existing literature is of poor study quality, with a high level of heterogeneity and risk of bias, rTSA appears to be a suitable option in appropriately selected patients undergoing oncologic resection and reconstruction of the proximal humerus. The most common complication is instability. Higher-quality evidence is needed to help guide decision making on appropriate implant utilization for patients undergoing oncologic resection of the proximal humerus.

Keywords: Reverse total shoulder arthroplasty; endoprosthesis; oncology; proximal humerus; reconstruction; tumor.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arthroplasty, Replacement, Shoulder*
  • Humans
  • Humerus / surgery
  • Joint Instability* / surgery
  • Male
  • Middle Aged
  • Range of Motion, Articular
  • Retrospective Studies
  • Shoulder
  • Shoulder Joint* / surgery
  • Treatment Outcome