Tikhoff-Linberg procedure for bone and soft tissue tumors of the shoulder girdle

Objective: To evaluate complications and the oncological and intermediate-t erm functional results in patients with bone and soft tissue tumors of the shoulder girdle who were managed with interscapulothoracic resection (Tikho ff-Linberg procedure). Design: Case series of 19 consecutive patients during a 10-year period at a mean follow-up of 6.3 years (range, 1-11 years). Setting: University hospital: referral center for musculoskeletal tumor sur gery. Patients: The initial diagnosis in this consecutive series of patients with shoulder girdle tumors requiring the Tikhoff-Linberg procedure was chondro sarcoma in 7 patients, Ewing sarcoma in 3 patients, malignant fibrous histi ocytoma in 3 patients, solitary metastasis of thyroid carcinoma in 2 patien ts, osteosarcoma, synovial sarcoma, angiosarcoma, and neurofibrosarcoma in 1 patient each. According to the Musculoskeletal Tumor Society staging syst em, there were 6 in surgical stage IB, 10 in stage TIE, and 3 in stage III. Nine tumors involved the proximal humerus, 8 were located in the scapula o r surrounding soft tissues, 1 in the lateral clavicle, and 1 in the acromio clavicular joint. Interventions: For reconstruction of the proximal humerus after en bloc tum or resection an isoelastic cemented shoulder tumor prosthesis was inserted in every patient to restore arm length. Main Outcome Measures: Complications, and oncological and intermediate-term functional results. Results: Twelve patients were alive with no evidence of disease. One of the se patients died of nontumorous disease 2 years after surgery. One patient is alive with pulmonary metastases after 12 months. Six patients died of me tastases at a mean (SD) interval of 18 months (range. 3-35 months) postoper atively. Two of these patients had additional local recurrence. A deep infe ction necessitated the explantation of the prosthesis in 1 patient. The mea n functional score and SD according re, the rating system of the Musculoske letal Tumor Society was 72% +/- 14% (range, 33%-87%) for the surviving pati ents evaluated. Major complications (1 infection and 2 local recurrences) t hat may be attributed to the procedure occurred in 3 of the 19 patients. Conclusion: Despite an overall complication rate of 74% the Tikhoff-Linberg procedure proved to be a valuable surgical procedure for extended tumors o f the shoulder girdle for functional and oncological outcome and is superio r to forequarter amputation.