Reverse total shoulder arthroplasty demonstrates improved functional outcomes and equivocal midterm survival compared to hemiarthroplasty following oncologic reconstruction in proximal humerus replacement
Bibliographic record
Abstract
BACKGROUND: Oncologic proximal humerus replacement (PHR) poses challenges because of disruption of the rotator cuff and capsule. We evaluated functional outcomes, implant survivorship, resection length, and stem-to-resection length ratio in patients undergoing hemiarthroplasty or reverse total shoulder arthroplasty (rTSA) with either endoprosthesis or allograft-prosthesis composite (APC) reconstruction. MATERIALS AND METHODS: This is a retrospective cohort study of 173 patients undergoing oncologic PHR between 1981 and 2024 (146 hemiarthroplasties; 27 rTSAs). Mean follow-up was 59.3 ± 81.9 months (hemiarthroplasty) and 24.9 ± 26.6 months (rTSA). Implant failures were classified using the Henderson system. Shoulder range of motion (ROM)-abduction, forward flexion (FF), and external rotation (ER)-was assessed at most recent follow-up. Independent t tests compared ROM between groups. Pearson correlation evaluated relationships between resection length and ROM. Stem-to-resection length ratios were analyzed for impact on implant survival. Kaplan-Meier analysis assessed implant survivorship. RESULTS: RTSA showed significantly greater ROM than hemiarthroplasty: abduction (109° vs. 32°), FF (110° vs. 34°), ER (38° vs. 17°) (P < .001, P < .001, and P = .002, respectively). In rTSA, abduction, FF, and ER did not correlate with resection length (P = .710, P = .910, and P = .710, respectively), and stem-to-resection length ratio did not predict survival. In resections below the deltoid tuberosity, APC reconstructions had worse FF (56° vs. 121°, P = .040). Time to failure was shorter in rTSA (2.1 vs. 55.2 months, P < .001), although overall survival did not differ (P = .710). CONCLUSION: RTSA yields superior ROM compared with hemiarthroplasty without compromising implant longevity. APC use below the deltoid tuberosity may reduce functional outcomes. Early rTSA failures warrant improved follow-up and multicenter analysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".