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Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review

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Clinical Orthopaedics and Related Research®

Abstract

Background

Tumors of the appendicular skeleton commonly affect the proximal humerus, but there is no consensus regarding the best reconstructive technique after proximal humerus resection for tumors of the shoulder.

Questions/purposes

We wished to perform a systematic review to determine which surgical reconstruction offers the (1) best functional outcome as measured by the Musculoskeletal Tumor Society (MSTS) score, (2) longest construct survival, and (3) lowest complication rate after proximal humerus resection for malignant or aggressive benign tumors of the shoulder.

Methods

We searched the literature up to June 1, 2013, from MEDLINE, EMBASE, and the Cochrane Library. Only studies reporting results in English, Dutch, or German and with followups of 80% or more of the patients at a minimum of 2 years were included. Twenty-nine studies with 693 patients met our criteria, seven studies (24%) were level of evidence III and the remainder were level IV. Studies reported on reconstruction with prostheses (n = 17), osteoarticular allografts (n = 10), and allograft-prosthesis composites (n = 11). Owing to substantial heterogeneity and bias, we narratively report our results.

Results

Functional scores in prosthesis studies ranged from 61% to 77% (10 studies, 141 patients), from 50% to 78% (eight studies, 84 patients) in osteoarticular graft studies, and from 57% to 91% (10 studies, 141 patients) in allograft-prosthesis composite studies. Implant survival ranged from 0.38 to 1.0 in the prosthesis group (341 patients), 0.33 to 1.0 in the osteoarticular allograft group (143 patients), and 0.33 to 1.0 in allograft-prosthesis group (132 patients). Overall complications per patient varied between 0.045 and 0.85 in the prosthesis group, 0 and 1.5 in the osteoarticular graft group, and 0.19 and 0.79 in the prosthesis-composite graft group. We observed a higher fracture rate for osteoarticular allografts, but other specific complication rates were similar.

Conclusions

Owing to the limitations of our systematic review, we found that allograft-prosthesis composites and prostheses seem to have similar functional outcome and survival rates, and both seem to avoid fractures that are observed with osteoarticular allografts. Further collaboration in the field of surgical oncology, using randomized controlled trials, is required to establish the superiority of any particular treatment.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital–Harvard Medical School, Room 3.946, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA

    Teun Teunis MD, Sjoerd P. F. T. Nota MD, Francis J. Hornicek MD, PhD, Joseph H. Schwab MD, MS & Santiago A. Lozano-Calderón MD, PhD

  2. Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital–Harvard Medical School, Boston, MA, USA

    Francis J. Hornicek MD, PhD

  3. Spine Surgery Service, Massachusetts General Hospital–Harvard Medical School, Boston, MA, USA

    Joseph H. Schwab MD, MS

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  1. Teun Teunis MD
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  2. Sjoerd P. F. T. Nota MD
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  3. Francis J. Hornicek MD, PhD
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  4. Joseph H. Schwab MD, MS
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  5. Santiago A. Lozano-Calderón MD, PhD
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Correspondence to Teun Teunis MD.

Additional information

Help was received from the Harvard Catalyst, who is funded by: National Center for Research Resources, Center for advancing Translational Sciences, NIH award 8UL1TR000170-05, and financial contributions from Harvard University.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Teunis, T., Nota, S.P.F.T., Hornicek, F.J. et al. Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review. Clin Orthop Relat Res 472, 2245–2253 (2014). https://doi.org/10.1007/s11999-014-3474-4

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