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Case Reports
. 2020 Nov;10(8):63-67.
doi: 10.13107/jocr.2020.v10.i08.1862.

Traumatic Glenosphere Dissociation Following Reverse Total Shoulder Endoprosthetic Reconstruction for Proximal Humerus Periosteal Chondrosarcoma: A Case Report

Affiliations
Case Reports

Traumatic Glenosphere Dissociation Following Reverse Total Shoulder Endoprosthetic Reconstruction for Proximal Humerus Periosteal Chondrosarcoma: A Case Report

Michael M Chau et al. J Orthop Case Rep. 2020 Nov.

Abstract

Introduction: Reverse total shoulder endoprosthetic reconstruction after margin-negative tumor resection of the proximal humerus is becoming more conventional in orthopeadic oncology practices. Mid-term survival and functional outcomes have been satisfactory. This case report corroborates with current literature and further describes a rare traumatic complication.

Case presentation: We report a case of a 70-year-old male with periosteal chondrosarcoma of the proximal humerus who underwent margin-negative resection and reverse total shoulder endoprosthetic reconstruction that was complicated by glenosphere dissociation sustained from falling onto a hyperflexed arm. Successful revision arthroplasty was performed.

Conclusion: Enhancing glenohumeral joint stability after wide resection of the proximal humerus is important to address rotator cuff insufficiency. The greater levering effect of a longer humeral prosthesis used to increase soft tissue tension may also increase the risk of glenosphere dissociation secondary to trauma. Proper soft-tissue tensioning and surgical technique are critical.

Keywords: Glenosphere dissociation; periosteal chondrosarcoma; reverse total shoulder endoprosthetic reconstruction.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Initial imaging findings. Anteroposterior (a) and axillary (b) radiographs of the right proximal humerus demonstrating anterior and inferomedial chondroid mineralization. Coronal (c) and axial (d) T2-weighted magnetic resonance imaging of the right proximal humerus demonstrating endosteal scalloping of the anterior cortex. Coronal (e) and axial (f) T1-weighted MRI with fat suppression of the right proximal humerus demonstrating peripheral ring-and-arc enhancement. Anterior (g) and posterior (h) whole-body bone scan demonstrating increased isotope uptake at the right proximal humerus.
Figure 2
Figure 2
Histopathology of a percutaneous core biopsy of the proximal humeral mass demonstrating intermediate-grade periosteal chondrosarcoma. Histopathological samples were stained with hematoxylin and eosin. Low power (2x) micrograph shows cartilaginous tissue (purple) and cortical bone (pink). Medium power (10x) and high power (40x) micrographs show pathological cartilage with increased cellularity, occasional mitoses, moderate nuclear atypia, and muco-myxoid degeneration of the chondroid matrix.
Figure 3
Figure 3
Intraoperative findings during the index surgery. Intraoperative photographs demonstrating tumor dissection (a), resected proximal humerus measuring 12x2.5x2.5 cm and peri-humeral mass measuring 8x7.5x6.9 cm (b), endoprosthetic trialing to confirm fit (c), tendon reattachment via the prosthetic suture portals (d), and final endoprosthesis (e). Infra, infraspinatus tendon; supra, supraspinatus tendon; subscap, subscapularis tendon; CV, cephalic vein; AX, axillary nerve; MC, musculocutaneous nerve; PM, pectoralis major tendon; BL, biceps long head tendon; LD, latissimus dorsi tendon.
Figure 4
Figure 4
Postoperative X-ray 6 weeks after the index surgery. Grashey (a), scapular Y (b), and axillary (c) radiographs of the right proximal humerus after a reverse total shoulder endoprosthetic reconstruction.
Figure 5
Figure 5
Postoperative X-ray 2 years after the index surgery. Grashey (a), scapular Y (b), and axillary (c) radiographs of the right proximal humerus revealing complete glenosphere dissociation after the patient sustained a fall onto his arm in hyperflexion.
Figure 6
Figure 6
Intraoperative findings during the revision surgery. Intraoperative photographs demonstrating a completely disengaged glenosphere (a), inferior polyethylene wear and minimal fretting wear of the Morse taper (b), intact baseplate (c), and final revision arthroplasty with upsized glenosphere and humeral tray (d).
Figure 7
Figure 7
Postoperative X-rays 6 weeks after the revision surgery. Grashey (a), scapular Y (b), and axillary, (c) radiographs of the right proximal humerus after revision arthroplasty demonstrating a congruent glenohumeral joint with upsized glenosphere and humeral tray.

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