{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:34Z","timestamp":1787755354754,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,12,20]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Reverse total shoulder arthroplasty (RTSA) performed in the setting of massive proximal humeral bone loss often requires special reconstructive techniques. Restoration of the proximal part of the humerus with an allograft provides a number of theoretical benefits, including implant support, restoration of humeral length, deltoid tensioning, and an opportunity to repair the posterior aspect of the cuff to improve strength in external rotation and repair of the subscapularis to improve stability. However, reverse allograft-prosthesis composites (APCs) are costly, are technically demanding to use, and can be compromised by progressive allograft resorption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Between 2005 and 2012, the lead author used an APC reconstruction in 8 primary and 18 revision RTSAs (26 patients; mean age, 62 years; mean body mass index, 27.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). The indications for the primary RTSAs included severe proximal humeral bone loss after trauma (n = 5) and tumor resection (n = 3). The indications in the revision setting were failed hemiarthroplasty (n = 11), anatomic total shoulder arthroplasty (n = 4), and reverse arthroplasty (n = 3). The most common reason for revision was instability (n = 10). A compression plate was used for graft-to-host fixation in all shoulders. Shoulders were assessed for pain, motion, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, Neer score, revision or reoperation, radiographic evidence of graft union or resorption, and implant fixation. The mean duration of follow-up was 4 years (range, 2 to 10 years).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>RTSA using an APC construct resulted in substantial improvements in pain scores (p &lt; 0.0001), elevation (p &lt; 0.0001), and external rotation (p = 0.004). With the numbers available, there were no significant differences in clinical outcomes between primary and revision cases. No patients required revision surgery for nonunion at the host-allograft junction. The mean time to union was 7 months, with 1 patient requiring bone-grafting for delayed union. Other complications included dislocation, deep infection, graft fracture, and periprosthetic fracture distal to the previous APC construct in 1 patient each. The 2 and 5-year revision-free survival rate was 96%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Reconstruction of proximal humeral bone loss with an APC at the time of primary or revision RTSA is safe and effective, with acceptable functional outcomes and complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.01495","type":"journal-article","created":{"date-parts":[[2017,12,21]],"date-time":"2017-12-21T02:44:41Z","timestamp":1513824281000},"page":"2069-2076","source":"Crossref","is-referenced-by-count":78,"title":["Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty"],"prefix":"10.2106","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3199-3247","authenticated-orcid":false,"given":"Joaquin","family":"Sanchez-Sotelo","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin H.","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Houdek","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"24","key":"bib1-20230816","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.2106\/JBJS.N.00405","article-title":"Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae)","volume":"96","author":"Raiss","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib2-20230816","doi-asserted-by":"crossref","first-page":"292","DOI":"10.2106\/00004623-200702000-00010","article-title":"The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture","volume":"89","author":"Levy","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib3-20230816","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2106\/JBJS.H.00094","article-title":"Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite","volume":"91","author":"Chacon","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib4-20230816","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1302\/0301-620X.69B4.3611177","article-title":"Endoprosthetic replacement of the proximal humerus","volume":"69","author":"Ross","year":"1987","journal-title":"J Bone Joint Surg Br."},{"issue":"10","key":"bib5-20230816","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.2106\/JBJS.H.00815","article-title":"Allograft-prosthesis composite reconstruction of the proximal part of the humerus: functional outcome and survivorship","volume":"91","author":"Abdeen","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib6-20230816","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0030-5898(20)31630-8","article-title":"Allograft reconstructions of the shoulder after bone tumor resections","volume":"22","author":"Cheng","year":"1991","journal-title":"Orthop Clin North Am."},{"issue":"8","key":"bib7-20230816","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.2106\/00004623-199908000-00009","article-title":"Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus","volume":"81","author":"Getty","year":"1999","journal-title":"J Bone Joint Surg Am."},{"key":"bib8-20230816","first-page":"164","article-title":"Proximal humeral reconstruction after excision of a primary sarcoma","volume":"311","author":"Jensen","year":"1995","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib9-20230816","doi-asserted-by":"crossref","first-page":"334","DOI":"10.2106\/00004623-199072030-00004","article-title":"Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor","volume":"72","author":"Gebhardt","year":"1990","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib10-20230816","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.jse.2012.08.008","article-title":"Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary?","volume":"22","author":"Budge","year":"2013","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"bib11-20230816","doi-asserted-by":"crossref","first-page":"147S","DOI":"10.1016\/j.jse.2004.10.006","article-title":"Grammont reverse prosthesis: design, rationale, and biomechanics","volume":"14","author":"Boileau","year":"2005","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"bib12-20230816","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/j.jse.2008.12.013","article-title":"Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty","volume":"18","author":"Edwards","year":"2009","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"bib13-20230816","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1058-2746(09)80019-0","article-title":"A standardized method for the assessment of shoulder function","volume":"3","author":"Richards","year":"1994","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"bib14-20230816","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S1058-2746(98)90002-7","article-title":"Assessing the reliability and responsiveness of 5 shoulder questionnaires","volume":"7","author":"Beaton","year":"1998","journal-title":"J Shoulder Elbow Surg"},{"issue":"3","key":"bib15-20230816","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2106\/00004623-198264030-00001","article-title":"Recent experience in total shoulder replacement","volume":"64","author":"Neer","year":"1982","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib16-20230816","doi-asserted-by":"crossref","first-page":"657","DOI":"10.2106\/00004623-199405000-00005","article-title":"The effect of internal fixation on the healing of large allografts","volume":"76","author":"Vander Griend","year":"1994","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201712200-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:48Z","timestamp":1787751708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201712200-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,20]]},"references-count":16,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.01495","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,20]]}}}