JSES - 2026-04-24 - Journal Article
Complete resection of the deltoid insertion is associated with postoperative dislocation of reverse total shoulder arthroplasty following proximal humerus oncological resection.
Lin N, Zheng L, Li W, Huang X, Yan X, Liu M, Ye Z
Topics
Key Takeaway
Complete deltoid insertion resection carries a 16.67-fold increased odds of postoperative dislocation after rTSA for proximal humerus oncological resection, with instability accounting for 13 of 17 total complications.
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Summary
This retrospective cohort examined complications and functional outcomes in 58 patients undergoing rTSA for proximal humerus tumor resection, stratified by extent of deltoid insertion sacrifice. Multiple regression identified complete deltoid insertion resection as an independent risk factor for dislocation (OR 16.67, P<0.01), with instability occurring in 13 of 17 complication cases. In a matched comparison, rTSA outperformed aTSA in patients with complete deltoid resection across all functional scores (MSTS 26 vs. 21, Constant-Murley 76 vs. 50, TESS 136 vs. 101; all P<0.01).
Key Limitation
Resection length correlated with dislocation across the full cohort but lost significance within subgroups, suggesting the three-group deltoid stratification may be underpowered to detect dose-response effects of partial resection.
Original Abstract
BACKGROUND
Reconstruction of an oncologically resected proximal humerus poses a challenge to surgeons, and reverse total shoulder arthroplasty (rTSA) may provide greater functional improvement. However, the characteristics of patients suitable for rTSA remain unknown, owing to the lack of data in the literature regarding postoperative functional outcomes and complications. In this retrospective cohort study of patients who underwent rTSA for tumor-related proximal humerus resection, we aimed to identify the features related to improved outcomes and decreased complications. We hypothesized that complete deltoid resection would be associated with an increased risk of instability in patients treated with rTSA for oncological proximal humeral resection.
METHODS
We conducted a retrospective cohort study to assess the postoperative mid-term complications and functional outcomes. The range of motion, Musculoskeletal Society Tumor Score (MSTS), Toronto Extremity Salvage Score (TESS), and Constant-Murley score were used to evaluate functional outcomes. The patients were divided into three groups dependent on the resection of the deltoid insertion. Furthermore, 24 patients whose deltoid insertions were completely resected and who underwent anatomic shoulder arthroplasty (aTSA) were matched according to the demographic information of those who underwent rTSA.
RESULTS
Fifty-eight patients who underwent rTSA in our department were included in the study based on the inclusion and exclusion criteria. The MSTS, TESS, and Constant-Murley scores were 26, 136, and 76, and the average forward flexion, abduction, external rotation, and internal rotation angles were 126, 122, 52, and 51°, respectively. Complications were reported in 17 patients, with instability accounting for 13. Multiple regression analysis revealed that complete resection of the deltoid insertion was an independent risk factor for postoperative dislocation (odds ratio: 16.67; P < 0.01). Although resection length showed a significant positive association with dislocation in all patients, no association was found in the subgroups. We following match 24 patients with the complete resection of deltoid resection and aTSA and found poorer functional outcomes compared to that of patients undergoing rTSA (MSTS: 21, P < 0.01; Constant-Murley: 50, P < 0.01;
TESS
101, P < 0. 01).
CONCLUSION
Our findings demonstrate that rTSA provides satisfactory functional outcomes for treating proximal humeral tumors but that complete deltoid insertion resection is an independent risk factor for postoperative dislocation. In patients whose deltoid insertions are completely resected, functional improvements make them worth attempting in those with high activity demands.