Proximal Humerus Neoplasia

  • Raimondo PianaEmail author
  • Nicola Ratto
  • Andrea Ferro
  • Michele Boffano


The reconstruction of the proximal humerus following a tumor resection remains a big challenge for the orthopedic surgeon, due to the complex anatomy and biomechanics of the shoulder joint. The main goals, after a resection with adequate margins, are the stability of the glenohumeral joint and the restoration of passive and active mobility. The proximal humerus reconstruction can be performed with an allograft and/or an endoprosthetic replacement. The resected tendons should be resutured to the prosthesis or the allograft to improve the functional results. The shoulder joint reconstruction with a reverse shoulder prosthesis seems to allow the best functional results, in particular if the circumflex nerve and the deltoid muscle are spared.


Proximal humerus Bone and soft tissue tumor Reverse shoulder arthroplasty Allograft-prosthesis composite Shoulder Limb-sparing surgery Sarcoma 


  1. 1.
    Malawer MM. Overview of resections around the shoulder girdle: anatomy, surgical consideration and classifications. In: Musculoskeletal cancer surgery; 2001.Google Scholar
  2. 2.
    Enneking W, Dunham W, Gebhardt M, Malawar M, Pritchard D. A system for the classification of skeletal resections. Chir Organi Mov. 1990;75(1 Suppl):217–40.PubMedGoogle Scholar
  3. 3.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57(1):43–66.CrossRefGoogle Scholar
  4. 4.
    Aaron AD. Treatment of metastatic adenocarcinoma of the pelvis and the extremities. J Bone Joint Surg Am. 1997;79(6):917–32.CrossRefGoogle Scholar
  5. 5.
    Fottner A, Szalantzy M, Wirthmann L, Stähler M, Baur-Melnyk A, Jansson V, et al. Bone metastases from renal cell carcinoma: patient survival after surgical treatment. BMC Musculoskelet Disord. 2010;11:145.CrossRefGoogle Scholar
  6. 6.
    De Wilde L, Boileau P, Van der Bracht H. Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment? Clin Orthop. 2011;469(9):2489–95.CrossRefGoogle Scholar
  7. 7.
    Teunis T, Nota SPFT, Hornicek FJ, Schwab JH, Lozano-Calderón SA. Outcome after reconstruction of the proximal humerus for tumor resection: a systematic review. Clin Orthop. 2014;472(7):2245–53.CrossRefGoogle Scholar
  8. 8.
    Malawer MM. Tumors of the shoulder girdle. Technique of resection and description of a surgical classification. Orthop Clin North Am. 1991;22(1):7–35.PubMedGoogle Scholar
  9. 9.
    Bus MPA, van de Sande MA, Taminiau AHM, Dijkstra PDS. Is there still a role for osteoarticular allograft reconstruction in musculoskeletal tumour surgery? A long-term follow-up study of 38 patients and systematic review of the literature. Bone Joint J. 2017;99–B(4):522–30.Google Scholar
  10. 10.
    Streitbuerger A, Henrichs M, Gosheger G, Ahrens H, Nottrott M, Guder W, et al. Improvement of the shoulder function after large segment resection of the proximal humerus with the use of an inverse tumour prosthesis. Int Orthop. 2015;39(2):355–61.CrossRefGoogle Scholar
  11. 11.
    Cannon CP, Paraliticci GU, Lin PP, Lewis VO, Yasko AW. Functional outcome following endoprosthetic reconstruction of the proximal humerus. J Shoulder Elb Surg. 2009;18(5):705–10.CrossRefGoogle Scholar
  12. 12.
    Abdeen A, Healey JH. Allograft-prosthesis composite reconstruction of the proximal part of the humerus: surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 2):188–96.CrossRefGoogle Scholar
  13. 13.
    King JJ, Nystrom LM, Reimer NB, Gibbs CP, Scarborough MT, Wright TW. Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections. J Shoulder Elb Surg. 2016;25(1):45–54.CrossRefGoogle Scholar
  14. 14.
    Sheth M, Ko J-WK, Namdari S. Reverse shoulder arthroplasty and latissimus dorsi tendon transfer. Am J Orthop (Belle Mead NJ). 2017;46(5):E287–92.Google Scholar
  15. 15.
    Wey A, Dunn JC, Kusnezov N, Waterman BR, Kilcoyne KG. Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: a systematic review. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718398.CrossRefGoogle Scholar
  16. 16.
    van de Sande MAJ, Dijkstra PDS, Taminiau AHM. Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction. Int Orthop. 2011;35(9):1375–80.Google Scholar
  17. 17.
    De Wilde LF, Plasschaert FS, Audenaert EA, Verdonk RC. Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery. Clin Orthop. 2005;430:156–62.CrossRefGoogle Scholar
  18. 18.
    Guven MF, Aslan L, Botanlioglu H, Kaynak G, Kesmezacar H, Babacan M. Functional outcome of reverse shoulder tumor prosthesis in the treatment of proximal humerus tumors. J Shoulder Elb Surg. 2016;25(1):e1–6.CrossRefGoogle Scholar
  19. 19.
    Bonnevialle N, Mansat P, Lebon J, Laffosse J-M, Bonnevialle P. Reverse shoulder arthroplasty for malignant tumors of proximal humerus. J Shoulder Elb Surg. 2015;24(1):36–44.CrossRefGoogle Scholar
  20. 20.
    Potter BK, Adams SC, Pitcher JD, Malinin TI, Temple HT. Proximal humerus reconstructions for tumors. Clin Orthop. 2009;467(4):1035–41.CrossRefGoogle Scholar
  21. 21.
    Kassab M, Dumaine V, Babinet A, Ouaknine M, Tomeno B, Anract P. Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(1):15–23.CrossRefGoogle Scholar
  22. 22.
    Kaa AKS, Jørgensen PH, Søjbjerg JO, Johannsen HV. Reverse shoulder replacement after resection of the proximal humerus for bone tumours. Bone Joint J. 2013;95–B(11):1551–5.CrossRefGoogle Scholar
  23. 23.
    Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2011;20(1):146–57.CrossRefGoogle Scholar
  24. 24.
    Lädermann A, Walch G, Lubbeke A, Drake GN, Melis B, Bacle G, et al. Influence of arm lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2012;21(3):336–41.CrossRefGoogle Scholar
  25. 25.
    Raiss P, Kinkel S, Sauter U, Bruckner T, Lehner B. Replacement of the proximal humerus with MUTARS tumor endoprostheses. Eur J Surg Oncol. 2010;36(4):371–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Raimondo Piana
    • 1
    Email author
  • Nicola Ratto
    • 1
  • Andrea Ferro
    • 1
  • Michele Boffano
    • 1
  1. 1.Orthopedic Oncologic SurgeryCTO Hospital, AOU Città della Salute e della ScienzaTorinoItaly

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