Allograft Prosthetic Composites in Complex Primary and Revision Shoulder and Elbow Arthroplasty

Substantial bone loss at the time of complex primary and revision shoulder or elbow arthroplasty is challenging. Large bone defects compromise component support and important muscle-tendon units. Megaprosthesis, osteoarticular allografts, vascularized bone transfers, fusions, and allograft prosthetic composites (APCs) have all been described for reconstruction in these difficult situations. APCs increase bone stock and provide a better opportunity for soft-tissue reconstruction; however, they are prone to other complications, including graft resorption, nonunion, and fracture. This article provides a comprehensive understanding and review of the benefits and disadvantages of APC utilization in shoulder and elbow arthroplasty. Technical considerations are discussed to maximize functional outcomes. Moreover, advances in templating and three-dimensional printing offer a promising future for planning, precise preparation, and surgical efficiency of APC use in upper extremity arthroplasty.