Total Scapula Prosthetic Replacement 

A total scapula prosthetic replacement is a procedure that involves removing a tumor, which usually malignant or benign aggressive, of the scapula/shoulder girdle and replacing the shoulder with a special customizable total shoulder prosthesis called total scapula prosthesis with a proximal humerus component. It is often used to reconstruct the shoulder after limb sparing surgery for a sarcoma arising from or involving the scapula.

Scapula Xr 2

What is Limb Sparing Surgery of the Shoulder Blade/Scapula?

The shoulder girdle, as seen in the figure below, consists of the proximal humerus, scapula, and clavicle. The shoulder joint is formed by the glenoid (cup), which is part of the scapula, and the proximal humerus ball, which is the upper portion of your arm. There are many muscles that attach to your scapula, including the rotator cuff muscles. The scapula, also known as your shoulder blade, is a common site for primary sarcomas to arise. Some of these include chondrosarcoma, osteosarcoma and Ewing’s sarcoma. Soft tissue sarcomas can also develop around the scapula and shoulder, and invade the adjacent bones.  Limb-sparing surgery can be performed for approximately 95% of tumors arising from or around the shoulder girdle. In order to reconstruct the shoulder girdle with a total scapula prosthesis one must be able to preserve the deltoid muscle and axillary nerve, trapezius muscle, rhomboids and latissimus. In some instances, the extremity cannot be saved, and a forequarter amputation is performed. 

Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, invasion of the chest wall, extensive disease, contamination from a poorly performed biopsy, recurrent disease. 


What’s involved in the technique?

What you can expect afterwards

After your surgery you will spend a few nights in the hospital and then will be recuperating at home or at a rehabilitation center. Various pain protocols and nerve blocks are used to minimize pain. Mostly, all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery for a post-operative visit. Patients are usually kept in a sling for 6 weeks to allow the muscles to heal. The elbow is not permitted to extend beyond 45 degrees of flexion for 4 to 6 weeks to allow the biceps muscle to heal which will stabilize the prosthesis. Once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.  

You will be monitored periodically with X-rays over the course of 5 years. Sometimes an MRI and/or CT may be used to additionally monitor the area to make sure the tumor has not come back. You will then have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the bone integrity has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy. 

Types Of Physical Therapy

Total Scapula Prosthetic Replacement Surgical Video

Dr. James Wittig narrates a video illustrating the surgical technique for a total scapula prosthetic replacement surgery. | WATCH VIDEO