Custom-made scapular reconstructions after resections for primary tumors: functional outcomes using different prosthetic design in a series of eight cases

Background Restoration of shoulder function after resection for primary bone tumors of the scapula is a challenge, according to the sacrifice of rotator cuff muscles and glenoid. This study aims to define the advantages of a prosthetic design over the others in different clinical situations, comparing the functional outcomes and complication rate of patients treated for a primary tumor of the scapula or surrounding soft tissue with resection and reconstruction with custom-made prostheses. Materials and methods Eight patients were retrospectively reviewed; seven underwent total scapulectomy, while one underwent partial. A humeral prosthesis was placed in five patients (four with constrained and one with anatomical design), and in one patient, a transposition of the latissimus dorsi was performed, in order to replace the deltoid muscle. Results At a median follow-up of 55 months (24–97), two complications requiring further surgeries (a local recurrence and a wound dehiscence) were assessed in two patients, all managed without scapular prosthesis removal. The median MSTS score was 24 (14–30); in the group of constrained prosthesis, the median MSTS score was 24 (19–26), while in the group of nonconstrained prosthesis it was 19 (14–26). The patient with partial scapular reconstruction scored 30 points. Conclusions After resection of the scapula, custom-made prostheses represent an effective reconstruction, with good functional results and low complication rate. In patients in whom the rotator cuff and its innervation are preserved, an anatomic design seems to allow for good functional results; after rotator cuff sacrifice, a constrained prosthetic design in our experience seems to allow for a stable and painless shoulder with acceptable functional results. Level of evidence: IV.