Background: Reverse total shoulder arthroplasty (rTSA) for proximal humerus bone loss is linked with increased risks of complications and reoperation. This study aimed to compare the complication and reoperation rates between patients with unaddressed humeral defect (control group [CG]) and those receiving proximal humerus allograft prosthesis composite (APC) or mega-prosthesis (MP) (study group [SG]).

Methods: Systematic searches were conducted in MEDLINE/PubMed, Web of Science, and Embase to find studies on rTSA outcomes in proximal humerus bone loss cases. Search terms included boolean combinations of "proximal humerus bone loss," "revision shoulder replacement," "arthroplasty," "prosthesis," and "reconstruction." Studies with <24 months follow-up, humeral defects over 7 cm or under 3 cm, case reports, and oncologic resections were excluded. Study design, demographic data, surgical methods, and outcomes were extracted and analyzed. A proportional meta-analysis compared complication and reoperation rates between CG and SG, with subgroup analyses for APC and MP. Multivariate logistic regression identified predictive prognostic factors, using the modified Coleman Methodology Score for bias risk assessment.

Results: Thirteen studies were included; seven (167 cases) in CG, four (113 cases) in SG treated with APC, and two (51 cases) with MP. The two groups were comparable in modified Coleman Methodology Score, age, sex, medium follow-up, preoperative visual analog scale, elevation, number of previous surgeries, medium bone loss, and preoperative diagnosis. No significant differences were found in complication and reoperation rates between CG and SG or between APC and MP groups (P = .3, .6, .19, and .36, respectively). Only preoperative infection was associated with higher complications and reoperation rates (P = .04 and P = .015, respectively).

Conclusion: Using APC or MP during rTSA in case of Proximal Humeral Arthroplasty Revision Osseous inSufficiency (PHAROS) 2 bone loss is neither associated with a lower complication and reoperation rate nor with better postoperative pain or elevation. Patients affected by preoperative infection are at higher risk of developing symptomatic complications and suffer reoperation.

Keywords: Pharos; Reverse shoulder arthroplasty; allograft; complication; megaprosthesis; proximal humeral bone loss; reoperation; revision.

© 2025 The Author(s).

背景： 反向全肩关节置换术（rTSA）用于近端肱骨骨缺损与并发症和再手术的风险增加有关。本研究旨在比较未处理的肱骨缺损患者组（对照组 [CG]）与接受近端肱骨异体移植假体复合物 (APC) 或大段假体 (MP) 治疗患者的组（研究组 [SG]）之间的并发症和再手术率。

方法： 在 MEDLINE/PubMed、Web of Science 和 Embase 中进行了系统检索，以寻找有关近端肱骨骨缺损病例中 rTSA 结果的研究。搜索词包括 "proximal humerus bone loss"（近端肱骨骨缺损）、"revision shoulder replacement"（肩关节置换术翻修手术）、"arthroplasty"（关节成形术）、"prosthesis"（假体）和 "reconstruction"（重建）的布尔组合。排除了随访时间小于24个月、肱骨缺陷超过7厘米或不足3厘米的研究，病例报告以及肿瘤切除研究。提取并分析了研究设计、人口统计学数据、手术方法和结果。采用比例元分析比较对照组 (CG) 和研究组 (SG) 的并发症和再手术率，并对 APC 和 MP 进行亚组分析。使用改良的 Coleman 方法评分进行偏倚风险评估，多变量逻辑回归确定预测预后因素。

结果： 共纳入13项研究；对照组7项（167例），研究组中4项（113例）接受 APC 治疗，2项（51例）接受 MP 治疗。两组在改良 Coleman 方法评分、年龄、性别、中位随访时间、术前视觉模拟量表、抬高幅度、既往手术次数、中位骨缺损和术前诊断方面具有可比性。对照组与研究组或 APC 组与 MP 组之间的并发症和再手术率无显著差异（P = .3，.6，.19 和 .36，分别）。只有术前感染与较高的并发症和再手术率相关（P = .04 和 P = .015）。

结论： 在近端肱骨关节成形术后骨性不全 (PHAROS) 2 型骨缺损情况下进行 rTSA 时，使用 APC 或 MP 既不会降低并发症和再手术率，也不会改善术后的疼痛或抬高幅度。受术前感染影响的患者有较高的风险出现症状性并发症并需要再次手术。

关键词： Pharos；反向肩关节置换术；异体移植；并发症；大段假体；近端肱骨骨缺损；再手术；翻修。

© 2025 The Author(s).