Reconstruction with constrained scapular prosthesis after total scapulectomy for scapular malignant tumor

Background: Surgical reconstruction after total scapulectomy presents a great challenge. Currently, the constrained scapular prosthesis reconstruction is considered as the most effective and promising method. However, the mid- to long-term functional outcomes and complications of this procedure are unclear. Methods: We retrospectively analyzed eight patients with scapular malignant tumors treated by total scapulectomy and constrained scapular prosthesis reconstruction between 2011 and 2013. The results of functional improvement were evaluated using MSTS-93 score at the final follow-up. We also analyzed tumor recurrence, metastases, and complications associated with the reconstruction procedure. Results: Three patients died of pulmonary metastasis, and five patients were alive at the final follow-up. For the five surviving patients, the mean follow-up period was 61.8 months (range, 51-72 months). Each patient recovered satisfactory contour of the shoulder. The mean MSTS-93 functional score of the upper extremity was 23.5 (range, 20-27). Rib fractures developed two patients, while prosthesis exposure occurred in one patient. No infection, skin flap necrosis, dislocation, and aseptic loosening developed in this small series. Pulmonary metastasis was observed in two patients (2/5). Conclusions: Although a few of prosthesis-related complications not reported in previous studies are observed during the mid- to long-term follow-up, reconstruction with a constrained scapular prosthesis can provide a stable shoulder joint, and obtained a satisfactory shoulder contour and an acceptable mid-to long-term functional outcomes.