Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhan ^1,2,3,4,5 , YAN Xiaobo ^1,2,3,4,5 , LIN Nong ^1,2,3,4,5 , HUANG Xin ^1,2,3,4,5 , LIU Meng ^1,2,3,4,5 , LI Hengyuan ^1,2,3,4,5 , LI Binghao ^1,2,3,4,5 , LI Xiumao ^1,2,3,4,5 , QU Hao ^1,2,3,4,5 , LIN Peng ^1,2,3,4,5 ,  YE Zhaoming ^1,2,3,4,5

1. Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P. R. China;
2. Orthopedics Research Institute of Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China;
3. Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou Zhejiang, 310009, P. R. China;
4. Zhejiang Provincial Clinical Medical Research Center for Motor System Diseases, Hangzhou Zhejiang, 310009, P. R. China;
5. International Chinese Musculoskeletal Research Society, Hangzhou Zhejiang, 310009, P. R. China;

Corresponding author：

YE Zhaoming, Email: yezhaoming@zju.edu.cn

Keywords：

Scapular tumor; three-dimensional printed prosthesis; limb salvage; reverse shoulder arthroplasty; total scapulaectomy

DOI：

10.7507/1002-1892.202204088

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Objective To investigate the effectiveness of three-dimensional (3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors. Methods Between November 2017 and December 2021, 5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula. There was 1 male and 4 females. The age ranged from 44 to 59 years, with an average of 50.4 years. There were 2 cases of chondro sarcoma, 1 case of high-grade osteosarcoma, 1 case of lung cancer with scapular metastasis, and 1 case of ligamentoid fibromatosis recurrence. The disease duration was 4-8 months, with an average of 5.8 months. According to the Musculoskeletal Tumor Society (MSTS) scapular girdle classification criteria, 4 cases of tumors involved both S1 and S2 zones, and 1 case involved S2 zone. The tumor diameters ranged from 4.2 to 11.2 cm, with an average of 6.1 cm. The operation time, intraoperative blood loss, and blood transfusion were recorded. During follow-up, the MSTS score was used to evaluate the recovery of limb function of the patients. The sink depth of the affected shoulder, complications, and oncological outcomes were observed. The position of the prosthesis was reviewed by imaging. Results The operation time ranged from 155 to 230 minutes, with an average of 189 minutes. The intraoperative blood loss was 100-1 500 mL, with a median of 600 mL. Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation. All incisions healed by first intention, and no complications such as infection occurred. All patients were followed up 4-22 months, with an average of 13 months. Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure. At last follow-up, the MSTS score of all patients was 73%-83%, with an average of 77.4%. The affected shoulder was 2-4 cm lower than the contralateral side, with an average of 3 cm. Imaging examinations showed that no prosthesis loosening, dislocation, or fracture occurred during follow-up. Conclusion Reverse shoulder arthroplasty with 3D printed total scapula can obtain good shoulder function and appearance. Patients have high acceptance and satisfaction with this surgical method.

Citation： WANG Zhan, YAN Xiaobo, LIN Nong, HUANG Xin, LIU Meng, LI Hengyuan, LI Binghao, LI Xiumao, QU Hao, LIN Peng, YE Zhaoming. Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 817-821. doi: 10.7507/1002-1892.202204088 Copy

1.	Song Y, Liu J, Cao L, et al. Clinical and imaging features of tumors in the scapula. Curr Med Imaging, 2022, 18(6): 674-683.
2.	Klein A, Birkenmaier C, Baur-Melnyk A, et al. Functional results after oncological scapula resections. J Shoulder Elbow Surg, 2022, 31(2): 333-340.
3.	Savvidou OD, Zampeli F, Georgopoulos G, et al. Total scapulectomy and shoulder reconstruction using a scapular prosthesis and constrained reverse shoulder arthroplasty. Orthopedics, 2018, 41(6): e888-e893.
4.	李健雄, 毕竟优, 赵雪林, 等. 人工全肩胛骨置换术治疗肩胛骨肿瘤的疗效研究. 中国修复重建外科杂志, 2020, 34(2): 179-183.
5.	Luo G, Zhang Y, Wang X, et al. Individualized 3D printing-assisted repair and reconstruction of neoplastic bone defects at irregular bone sites: exploration and practice in the treatment of scapular aneurysmal bone cysts. BMC Musculoskelet Disord, 2021, 22(1): 984. doi: 10.1186/s12891-021-04859-5.
6.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
7.	Shashaa MN, Hamza A, AlHashemi M, et al. A child with Ewing’s sarcoma in scapula: A rare case report. Int J Surg Case Rep, 2021, 85: 106182. doi: 10.1016/j.ijscr.2021.106182.
8.	Grossi S, D’Arienzo A, Sacchetti F, et al. One-step reconstruction with custom-made 3D-printed scapular prosthesis after partial or total scapulectomy. Surg Technol Int, 2020, 36: 341-346.
9.	Wellings EP, Mallett KE, Parkes CW, et al. Impact of tumour stage on the surgical outcomes of scapular chondrosarcoma. Int Orthop, 2022, 46(5): 1175-1180.
10.	Park JW, Kang HG, Kim JH, et al. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci, 2021, 26(2): 276-283.
11.	McCulloch RA, Frisoni T, Kurunskal V, et al. Computer navigation and 3D printing in the surgical management of bone sarcoma. Cells, 2021, 10(2): 195. doi: 10.3390/cells10020195.
12.	Beltrami G, Ristori G, Scoccianti G, et al. Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection: a report of two patients. BMC Cancer, 2018, 18(1): 1003. doi: 10.1186/s12885-018-4883-7.
13.	Fan H, Fu J, Li X, et al. Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature. World J Surg Oncol, 2015, 13: 308. doi: 10.1186/s12957-015-0723-2.
14.	Tang X, Guo W, Yang R, et al. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg, 2011, 20(7): 1163-1169.
15.	Puchner SE, Panotopoulos J, Puchner R, et al. Primary malignant tumours of the scapula—a review of 29 cases. Int Orthop, 2014, 38(10): 2155-2162.
16.	Masamed R, Learch TJ, Menendez LR. En bloc shoulder resection with total shoulder prosthetic replacement: indications and imaging findings. AJR Am J Roentgenol, 2008, 191(2): 482-489.
17.	Schwab JH, Athanasian EA, Morris CD, et al. Function correlates with deltoid preservation in patients having scapular replacement. Clin Orthop Relat Res, 2006, 452: 225-230.
18.	Tanaka K, Ozaki T. Management of elderly patients with bone and soft tissue sarcomas: JCOG Bone and Soft Tissue Tumor Study Group. Jpn J Clin Oncol, 2022, 52(6): 526-530.
19.	Liu X, He S, Yao X, et al. Development and validation of prognostic nomograms for elderly patients with osteosarcoma. Int J Gen Med, 2021, 14: 5581-5591.

1. Song Y, Liu J, Cao L, et al. Clinical and imaging features of tumors in the scapula. Curr Med Imaging, 2022, 18(6): 674-683.
2. Klein A, Birkenmaier C, Baur-Melnyk A, et al. Functional results after oncological scapula resections. J Shoulder Elbow Surg, 2022, 31(2): 333-340.
3. Savvidou OD, Zampeli F, Georgopoulos G, et al. Total scapulectomy and shoulder reconstruction using a scapular prosthesis and constrained reverse shoulder arthroplasty. Orthopedics, 2018, 41(6): e888-e893.
4. 李健雄, 毕竟优, 赵雪林, 等. 人工全肩胛骨置换术治疗肩胛骨肿瘤的疗效研究. 中国修复重建外科杂志, 2020, 34(2): 179-183.
5. Luo G, Zhang Y, Wang X, et al. Individualized 3D printing-assisted repair and reconstruction of neoplastic bone defects at irregular bone sites: exploration and practice in the treatment of scapular aneurysmal bone cysts. BMC Musculoskelet Disord, 2021, 22(1): 984. doi: 10.1186/s12891-021-04859-5.
6. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
7. Shashaa MN, Hamza A, AlHashemi M, et al. A child with Ewing’s sarcoma in scapula: A rare case report. Int J Surg Case Rep, 2021, 85: 106182. doi: 10.1016/j.ijscr.2021.106182.
8. Grossi S, D’Arienzo A, Sacchetti F, et al. One-step reconstruction with custom-made 3D-printed scapular prosthesis after partial or total scapulectomy. Surg Technol Int, 2020, 36: 341-346.
9. Wellings EP, Mallett KE, Parkes CW, et al. Impact of tumour stage on the surgical outcomes of scapular chondrosarcoma. Int Orthop, 2022, 46(5): 1175-1180.
10. Park JW, Kang HG, Kim JH, et al. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci, 2021, 26(2): 276-283.
11. McCulloch RA, Frisoni T, Kurunskal V, et al. Computer navigation and 3D printing in the surgical management of bone sarcoma. Cells, 2021, 10(2): 195. doi: 10.3390/cells10020195.
12. Beltrami G, Ristori G, Scoccianti G, et al. Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection: a report of two patients. BMC Cancer, 2018, 18(1): 1003. doi: 10.1186/s12885-018-4883-7.
13. Fan H, Fu J, Li X, et al. Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature. World J Surg Oncol, 2015, 13: 308. doi: 10.1186/s12957-015-0723-2.
14. Tang X, Guo W, Yang R, et al. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg, 2011, 20(7): 1163-1169.
15. Puchner SE, Panotopoulos J, Puchner R, et al. Primary malignant tumours of the scapula—a review of 29 cases. Int Orthop, 2014, 38(10): 2155-2162.
16. Masamed R, Learch TJ, Menendez LR. En bloc shoulder resection with total shoulder prosthetic replacement: indications and imaging findings. AJR Am J Roentgenol, 2008, 191(2): 482-489.
17. Schwab JH, Athanasian EA, Morris CD, et al. Function correlates with deltoid preservation in patients having scapular replacement. Clin Orthop Relat Res, 2006, 452: 225-230.
18. Tanaka K, Ozaki T. Management of elderly patients with bone and soft tissue sarcomas: JCOG Bone and Soft Tissue Tumor Study Group. Jpn J Clin Oncol, 2022, 52(6): 526-530.
19. Liu X, He S, Yao X, et al. Development and validation of prognostic nomograms for elderly patients with osteosarcoma. Int J Gen Med, 2021, 14: 5581-5591.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors

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