Abstract
The optimal method for reconstructing the proximal humerus in patients with tumors is controversial. To determine functional outcomes and complication rates after different types of reconstructions, we reviewed a consecutive series of 49 patients who underwent proximal humerus resection and osteoarticular allograft (17 patients), allograft-prosthetic composite (16), or endoprosthetic (16) reconstruction. Operative indications included primary malignancies (24 patients), metastatic disease (19), and benign aggressive disease (six). Implant revision was more common after osteoarticular reconstruction (five of 17) than after allograft-prosthetic composite (one of 16) or endoprosthetic (zero of 16) reconstructions. At a minimum followup of 24 months (median, 98 months; range, 24–214 months) in surviving patients, Musculoskeletal Tumor Society functional scores averaged 79% for the allograft-prosthetic composite, 71% for the osteoarticular allograft, and 69% for the endoprosthetic reconstruction cohorts. Shoulder instability was associated with abductor mechanism compromise and was more common after endoprosthetic reconstruction. Allograft fractures occurred in 53% of patients receiving osteoarticular allografts. We recommend allograft-prosthetic composite reconstruction for younger patients with primary tumors of bone and endoprosthetic reconstruction for older patients with metastatic disease. Because of the unacceptable complication rate, we do not recommend osteoarticular allograft reconstruction for routine use in the proximal humerus.
Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Asavamongkolkul A, Eckardt JJ, Eilber FR, Dorey FJ, Ward WG, Kelly CM, Wirganowicz PZ, Kabo JM. Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop Relat Res. 1999;360:207–220.
Bell RS. Treatment of axial skeleton bone metastases. Clin Orthop Relat Res. 2003;415(suppl):S198–S200.
Black AW, Szabo RM, Titelman RM. Treatment of malignant tumors of the proximal humerus with allograft-prosthesis composite reconstruction. J Shoulder Elbow Surg. 2007;16:525–533.
Bos G, Sim F, Pritchard D, Shives T, Rock M, Askew L, Chao E. Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res. 1987;224:178–191.
Chen WM, Chen TH, Huang CK, Chiang CC, Lo WH. Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty. J Bone Joint Surg Br. 2002;84:1156–1161.
Damron TA, Rock MG, O’Connor MI, Johnson M, An KN, Pritchard DJ, Sim FH. Functional laboratory assessment after oncologic shoulder joint resections. Clin Orthop Relat Res. 1998;348:124–134.
DeGroot H, Donati D, Di Liddo M, Gozzi E, Mercuri M. The use of cement in osteoarticular allografts for proximal humeral bone tumors. Clin Orthop Relat Res. 2004;427:190–197.
Eckardt JJ, Kabo M, Kelly CM, Ward WG, Cannon CP. Endoprosthetic reconstructions for bone metastases. Clin Orthop Relat Res. 2003;415(suppl):S254–S262.
Enneking WF, Dunham W, Gebhardt M, Malawer M, Pritchard DJ. A system for the classification of skeletal resections. Chir Organi Mov. 1990;75(suppl 1):217–240.
Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.
Gainor BJ, Buchert P. Fracture healing in metastatic bone disease. Clin Orthop Relat Res. 1983;178:297–302.
Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am. 1990;72:334–345.
Getty PJ, Peabody TD. Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am. 1999;81:1138–1146.
Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res. 2001;382:87–98.
Jensen KL, Johnston JO. Proximal humeral reconstruction after excision of a primary sarcoma. Clin Orthop Relat Res. 1995;311:164–175.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.
Kiss J, Sztrinkai G, Antal I, Kiss J, Szendroi M. Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elbow Surg. 2007;16:273–279.
Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM. Endoprosthetic replacement of the proximal humerus: long-term results. J Bone Joint Surg Br. 2003;85:717–722.
Lin PP, Mirza AN, Lewis VO, Cannon CP, Tu SM, Tannir NM, Yasko AW. Patient survival after surgery for osseous metastases from renal cell carcinoma. J Bone Joint Surg Am. 2007;89:1794–1801.
Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am. 1995;77:1154–1165.
Malawer MM, Meller I, Dunham WK. A new surgical classification system of shoulder-girdle resections: analysis of 38 patients. Clin Orthop Relat Res. 1991;267:33–44.
Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res. 1996;324:86–97.
Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–170.
O’Connor MI, Sim FH, Chao EYS. Limb salvage for neoplasms of the shoulder girdle. J Bone Joint Surg Am. 1996;78:1872–1888.
Rodl RW, Gosheger G, Gebert C, Lindner N, Ozaki T, Winkelman W. Reconstruction of the proximal humerus after wide resection of tumors. J Bone Joint Surg Br. 2002;84:1004–1008.
Sharma S, Turcotte RE, Isler MH, Wong C. Experience with cemented large segment endoprostheses for tumors. Clin Orthop Relat Res. 2007;459:54–59.
Sorger JI, Hornicek FJ, Zavatta M, Menzner JP, Gebhardt MC, Tomford WW, Mankin HJ. Allograft fractures revisited. Clin Orthop Relat Res. 2001;382:66–74.
Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD. Endoprosthetic reconstructions: long-term followup of 139 patients. Clin Orthop Relat Res. 2005;438:51–59.
Wedin R, Bauer HCF, Wersall P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999;358:128–139.
Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC. Metastatic bone disease: a study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res. 1990;251:213–219.
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Relat Res. 2004;420:239–250.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was supported by a restricted educational grant from Stryker and one of the authors (HTT) is a paid consultant of Stryker.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
About this article
Cite this article
Potter, B.K., Adams, S.C., Pitcher, J.D. et al. Proximal Humerus Reconstructions for Tumors. Clin Orthop Relat Res 467, 1035–1041 (2009). https://doi.org/10.1007/s11999-008-0531-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-008-0531-x