Endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus after tumor resection: Cost and benefits

Abstract

Background: Proximal end of the humerus is a common site for both primary and metastatic bone tumors. Limb salvage with endoprosthetic replacement is the most common means of reconstruction, but it has been proved that cement spacer are more beneficial for inferior shoulder function. Thus, limb salvage can be replaced by cheaper spacers especially in poor societies. Patients and methods: This study included 20 patients, of whom 14 were female, with a mean age of 40.4 years (range 12-60). Among the study population, six were diagnosed with osteosarcomas, two chondrosarcomas, two myeloma, two lymphoma, four metastatic carcinoma in the breast, two giant cell tumor, and two recurrent chondroplastoma. Limb salvage was successfully done in all patients: Tikhoff-Linberg type I in 12 cases and type V in 8. Endoprosthetic replacement was done in eight cases. An on-table fabricated cement spacer was used in 12 cases. Results: Follow-up ranged from 12 to 75 months, with a mean of 25.9 months. Functional outcome was almost comparable in both types of reconstruction, especially patient's satisfaction, with a mean function of 65%. Conclusion: A relatively expensive endoprosthesis could be replaced by a much cheaper cement spacer if their function is comparable.

Mesh patch and anchors can improve clinical results of prosthetic replacement after resection of primary proximal humerus malignant tumor

“…Although the function results were satisfactory, the score of lifting ability was still the lowest one in all the scoring. The previous reports 17, [21][22][23][24][25][26][27][28][29][30] showed the functional scores after proximal humerus prosthesis reconstruction ranged from 60 to 80%.…”

“…The previous reports (systematic review with 341 patients) 30 showed large discrepancy of prosthesis survival in different studies which ranged from 38 to 100%. The incidence of complications was between 5 and 22% in different reports 17,[21][22][23][24][25][26][27][28][29][30] .…”

“…With the extensive application of prosthesis reconstruction and the improvement of surgical technology, the overall function and patient satisfaction are acceptable. But there are common problem of limited mobility, especially limited shoulder abduction 22 , 23 . In addition, postoperative joint instability and dislocation of the prosthetic humeral head are also common complications.…”

<p>Quality of life of patients with proximal humerus metastasis treated with cement spacer</p>

“…Patients with metastatic bone disease are not only concerned about whether the disease is curable, but also about the impact of treatment on their QOL. As a result, oncologists treat these patients with the aim of improving their QOL 1,13. In many clinical trials, a QOL assessment scale was used to evaluate the effectiveness of treatment, especially when it comes to incurable disease 14.…”

“…The proximal humerus is a common site of bone metastasis. Lesions at this location often occur in the advanced stages of cancer 1. Pathological fractures of the proximal humerus are common, and usually require a long time to heal, while up to 50% of the cases never heal 3.…”