Shoulder Reconstruction After Sarcoma Surgery

Sarcoma is a rare type of cancer that affects the body’s connective tissues, including bones, muscles, fat and cartilage. The upper portion of the arm bone (proximal humerus) is one of the most common sites of bone cancer. Tumors that can potentially develop in this area include primary cancers, such as osteosarcomas and Ewing sarcomas that originate in the arm bone, as well as secondary cancers that develop elsewhere in the body and then spread (metastasize) to the proximal humerus.

When a tumor occurs in the upper arm bone near the shoulder, it can weaken the joint structure and interfere with normal movement, often requiring specialized surgical care to remove the cancer and preserve arm function. Without resorting to amputation, complete removal of the tumor may necessitate taking out a large portion of the bone and surrounding tissues. Because the shoulder is a highly complex and intricate ball-and-socket joint, this type of procedure can affect the muscles and tendons needed for movement.

Options for shoulder reconstruction after bone cancer surgery

Shoulder reconstruction options, such as donor bone grafts, partial joint replacements and combined donor-bone-and-implant procedures, have been used for many years. However, these approaches often result in limited shoulder movement and strength. They are also associated with certain risks, especially if the rotator cuff becomes compromised or must be removed to ensure safe margins. Potential complications include implant failure, poor healing and long-term instability, which can make everyday activities more difficult over time.

Reverse shoulder technology is a promising new solution that allows for improved shoulder function. When possible, today’s surgeons can use advanced techniques and specialized implants to preserve the limb and rebuild the shoulder, helping the patient regain as much strength, stability and movement as possible.

How a skilled surgeon can rebuild the shoulder

During a surgical reconstruction procedure, the surgeon may use a specialized implant (endoprosthesis) to replace the removed bone and other joint tissues. Using modular metal shoulder components, sometimes in combination with donor tissue (allograft), the surgeon can reconstruct the missing bone.

One innovative technique is reverse shoulder reconstruction. When performing this procedure, the surgeon will reshape the shoulder joint so that the main arm muscle (deltoid) can lift the arm even if key shoulder tendons have been removed. This approach, which essentially reverses the articular components of the shoulder, can also improve joint stability. Studies show that patients with this reverse design generally experience better shoulder function and fewer complications than those who receive a more traditional implant.

What are the potential benefits of reverse shoulder reconstruction?

For a patient who is facing shoulder reconstruction after sarcoma surgery, reverse shoulder reconstruction can:

• Remove the tumor with wide margins
• Preserve the affected limb
• Restore the length and shape of the arm
• Increase the ability to perform daily tasks
• Improve comfort and motion after surgery

Rehabilitation and physical therapy after surgery remain important aspects of recovery. The goals are to help the patient regain strength and adapt to the changes in their shoulder.

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Benefit from world-class care at Moffitt Cancer Center

In Moffitt’s comprehensive Sarcoma Program, patients facing the challenges of upper extremity oncologic reconstruction can benefit from the expertise of a leading specialist in this surgical field. In certain cases, endoprosthetic or massive reverse total shoulder arthroplasty (RTSA) can be a promising option for improved shoulder function, even without a functional rotator cuff. Our surgeons achieve optimal results through specific preoperative planning and protocols that can maximize the effectiveness of each procedure, reduce complications and better tailor care to individual needs. We also offer our patients unique opportunities to participate in promising clinical trials, which are continually improving outcomes for cancer patients requiring complex shoulder reconstruction.

If you would like to learn more about shoulder reconstruction after sarcoma surgery, you can request a consultation with a member of Moffitt’s orthopedic oncology team by calling 1-888-663-3488 or submitting a new patient registration form online. We specialize in developing tailored treatment plans that incorporate state-of-the-art surgical options and supportive care services, and we do not require referrals.