{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:22:41Z","timestamp":1792466561322,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft\u2013prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 \u00b1 3.8 (74.3% \u00b1 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 \u00b1 5.2 vs. 26.6 \u00b1 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results.<\/jats:p>","DOI":"10.3390\/jcm14217850","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:06:06Z","timestamp":1762362366000},"page":"7850","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Glenohumeral Instability and Clinical Outcomes Following Proximal Humerus Resection and Megaprosthesis Implantation: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1439-2917","authenticated-orcid":false,"given":"Luigi","family":"Cianni","sequence":"first","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9565-6691","authenticated-orcid":false,"given":"Giacomo","family":"Capece","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Orthopaedics and Trauma Surgery Unit, Pellegrini Hospital, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Fiore","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8321-532X","authenticated-orcid":false,"given":"Andrea","family":"De Fazio","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Martellini","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Maccauro","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-8762","authenticated-orcid":false,"given":"Maristella Francesca","family":"Saccomanno","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"ref_1","first-page":"7","article-title":"Proximal humerus reconstruction in orthopedic oncology","volume":"7","author":"Pinnamaneni","year":"2021","journal-title":"J. Cancer Metastasis Treat."},{"key":"ref_2","first-page":"184","article-title":"Management of common upper limb fractures in adults","volume":"40","author":"Adam","year":"2022","journal-title":"Surgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s44174-023-00087-8","article-title":"Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective","volume":"2","author":"Kulkarni","year":"2023","journal-title":"Biomed. Mater. Devices"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Theil, C., Schwarze, J., Gosheger, G., Moellenbeck, B., Schneider, K.N., Deventer, N., Klingebiel, S., Grammatopoulos, G., Boettner, F., and Schmidt-Braekling, T. (2022). Implant Survival, Clinical Outcome and Complications of Megaprosthetic Reconstructions Following Sarcoma Resection. Cancers, 14.","DOI":"10.3390\/cancers14020351"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1016\/j.jse.2023.12.020","article-title":"Reverse shoulder arthroplasty megaprosthesis for surgical management of severe proximal humeral bone loss","volume":"33","author":"Atwan","year":"2024","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jht.2017.03.005","article-title":"Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management","volume":"30","author":"Warby","year":"2017","journal-title":"J. Hand Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Moisan, G., and Ma, C.Z.-H. (2024). Advances in prosthetics and orthotics. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07246-y"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"415","DOI":"10.5435\/00124635-200907000-00002","article-title":"Shoulder arthroplasty: Prosthetic options and indications","volume":"17","author":"Wiater","year":"2009","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ocl.2022.02.001","article-title":"Soft Tissue Management in Shoulder Arthroplasty","volume":"53","author":"Romero","year":"2022","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/00003086-200112000-00030","article-title":"Soft tissue reconstruction of megaprostheses using a trevira tube","volume":"393","author":"Gosheger","year":"2001","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s12306-024-00815-3","article-title":"The Musculoskeletal Tumor Society Scoring system is a valid subjective and objective tool to evaluate outcomes of surgical treatment of patients affected by upper and lower extremity tumors","volume":"108","author":"Rizzo","year":"2024","journal-title":"Musculoskelet. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0266-7681(02)00303-0","article-title":"Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation","volume":"28","author":"Padua","year":"2003","journal-title":"J. Hand Surg. Br."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (minors): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/CORR.0000000000000354","article-title":"Do Early Results of Proximal Humeral Allograft-Prosthetic Composite Reconstructions Persist at 5-year Followup?","volume":"477","author":"Liu","year":"2019","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_17","first-page":"450","article-title":"Reconstruction of the proximal humerus for bone neoplasm using an anatomic prosthesis-bone graft composite","volume":"78","author":"Hartigan","year":"2012","journal-title":"Acta. Orthop. Belg."},{"key":"ref_18","first-page":"37","article-title":"Endoprosthetic replacement for tumors of the proximal humerus","volume":"48","author":"Rahman","year":"2013","journal-title":"Egypt. Orthop. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00264-014-2597-2","article-title":"Endoprosthetic reconstruction of the proximal humerus after tumour resection with polypropylene mesh","volume":"39","author":"Wang","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1007\/s00264-010-1152-z","article-title":"Proximal humerus reconstruction after tumour resection: Biological versus endoprosthetic reconstruction","volume":"35","author":"Dijkstra","year":"2011","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wang, S., Luo, Y., Wang, Y., Zhang, Y., Gong, T., Tu, C., and Zhou, Y. (2022). Early functional and therapeutic effect of reversed tumour shoulder prosthesis reconstruction after proximal humerus tumour resection. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.987161"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jse.2006.12.006","article-title":"Treatment of malignant tumors of the proximal humerus with allograft-prosthesis composite reconstruction","volume":"16","author":"Black","year":"2007","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1757-7861.2009.00058.x","article-title":"Functional outcomes and complications of reconstruction of the proximal humerus after intra-articular tumor resection","volume":"2","author":"Wang","year":"2010","journal-title":"Orthop. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3571","DOI":"10.3390\/curroncol30040272","article-title":"Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases","volume":"30","author":"Meschini","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rachbauer, A.M., Schneider, K.N., Gosheger, G., and Deventer, N. (2023). Endoprosthetic Reconstruction of the Proximal Humerus with an Inverse Tumor Prosthesis. Cancers, 15.","DOI":"10.3390\/cancers15225330"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/CORR.0000000000002969","article-title":"What is the Revision-free Survival of Resurfaced Allograft-prosthesis Composites for Proximal Humerus Reconstruction in Children with Bone Tumors?","volume":"482","author":"Errani","year":"2024","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1053\/j.sart.2022.12.006","article-title":"Functional outcomes of oncologic reverse total shoulder arthroplasty after tumor resection","volume":"33","author":"Kang","year":"2023","journal-title":"Semin. Arthroplast. JSES"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5732\/cjc.009.10287","article-title":"Prosthesis replacement of the proximal humerus after the resection of bone tumors","volume":"29","author":"Shi","year":"2010","journal-title":"Chin. J. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jse.2013.06.010","article-title":"Large metaphyseal volume hemiprostheses for complex fractures of the proximal humerus","volume":"23","author":"Fucentese","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1007\/s00264-020-04576-z","article-title":"High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections","volume":"44","author":"Tagliero","year":"2020","journal-title":"Int. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10665","DOI":"10.2147\/CMAR.S232051","article-title":"The Personalized Shoulder Reconstruction Assisted by 3D Printing Technology After Resection of the Proximal Humerus Tumours","volume":"11","author":"Hu","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.ejso.2009.11.001","article-title":"Replacement of the proximal humerus with MUTARS tumor endoprostheses","volume":"36","author":"Raiss","year":"2010","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Hosseini, H., Heydari, S., Hushmandi, K., Daneshi, S., and Raesi, R. (2025). Bone tumors: A systematic review of prevalence, risk determinants, and survival patterns. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-13720-0"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1186\/1477-7819-12-330","article-title":"Modular tumor endoprostheses in surgical palliation of long-bone metastases: A reduction in tumor burden and a durable reconstruction","volume":"12","author":"Henrichs","year":"2014","journal-title":"World J. Surg. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1302\/2058-5241.6.210014","article-title":"Biomechanics of anatomic and reverse shoulder arthroplasty","volume":"6","author":"Goetti","year":"2021","journal-title":"EFORT Open Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.2106\/JBJS.ST.17.00051","article-title":"Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty","volume":"8","author":"Wagner","year":"2018","journal-title":"JBJS Essent. Surg. Tech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1016\/j.jse.2024.10.003","article-title":"The effect of reverse shoulder arthroplasty design and surgical indications on deltoid and rotator cuff muscle length","volume":"34","author":"Maxwell","year":"2025","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jse.2022.06.006","article-title":"The reliability of revision rates following primary shoulder arthroplasty as a quality indicator to rank hospital performance: A national registry analysis including 13,104 shoulders and 87 hospitals","volume":"32","author":"Hoogervorst","year":"2023","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7850\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T09:34:45Z","timestamp":1762421685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":39,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217850"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217850","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]}}}