Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma

Abstract

Background Improved patient and limb survival rates have led to an increased interest in the functional outcome and return to sports of patients undergoing megaprosthetic reconstruction in musculoskeletal oncology. This study evaluates the functional outcome and postoperatively performed level of sports in patients undergoing proximal humeral replacement (PHR) following resection of a primary bone sarcoma and identifies potential beneficial and limiting factors. Patients and methods Between 2007 and 2020, a total of 606 patients underwent resection of a primary bone sarcoma and reconstruction with a single-design modular implant. For 112 (18%) patients, the location of the tumour was the proximal humerus. Exclusion criteria were death (n = 65), patients living overseas (n = 8), and subsequent amputation (n = 1), leaving 38 patients for evaluation, of whom 32 were available for the study (13 women, median age 42 years). Clinical data regarding oncological and surgical treatment as well as subsequent complications were obtained from the patients’ electronic medical records. Functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS) and Toronto Extremity Salvage Score (TESS) as well as the Subjective Shoulder Value (SSV). Return to sports was assessed using the Tegner Activity Score (TS) and the modified Weighted Activity Score (WAS). Results At the last follow-up after a median of 30 months (IQR 22–58), median MSTS was 18 (IQR 12–24), median TESS was 80% (IQR 69–87), median SSV was 35% (IQR 10–58), median TS was 5 (IQR 4–6) and median WAS was 5 (IQR 0–10). Preservation of the axillary nerve, a reverse shoulder reconstruction and a WAS of > 10 prior to surgery were associated with better functional outcome and return to sports activity scores. Conclusion Following PHR, good to excellent functional outcomes are possible, and patients regularly return to participate in sports activities—most commonly in low-impact types of sports, but some individuals are even able to participate in high-impact sports activities. Level of evidence IV.

Distal Humeral Replacement in Patients with Primary Bone Sarcoma: The Functional Outcome and Return to Sports

“…Only a few studies have investigated the resumption of sporting activities following megaprosthetic reconstructions in oncological patient cohorts, although they have become increasingly important with the continuous improvements in patient life expectancy and quality of life [ 10 , 12 , 13 ]. For the upper extremity, Lang et al reported a return-to-sport rate of 100% in 18 patients who had undergone a proximal humeral replacement (PHR) after the resection of a primary bone sarcoma [ 13 ].…”

“…The WAS summarizes patients’ individual performance, by multiplying the frequency (sessions per week), duration (in hours), and impact of each performed sports activity (low-impact sports activity = 1, high-impact sports activity = 3; Table 2 ) [ 21 , 22 ]. The final WAS is obtained by adding the individual scores of each sports activity, whereby a WAS of 0–10 marks a low-activity patient, and a WAS of >10 denotes a high-activity patient [ 10 , 21 ].…”

“…Due to the rarity of distal humerus megaprosthetic reconstruction, and the high likelihood of complications such as implant failure or elbow stiffness, the data on the postoperative functional outcome and the potential return to sports activities are limited [ 6 , 7 , 8 , 9 ]. Continuous improvements in diagnostics, surgical, and oncological treatment have led to an increased patient life expectancy [ 10 , 11 ]. Thus, for long-term surviving patients, the functional outcome and participation in sports are growing in importance [ 10 , 12 , 13 , 14 ].…”

“…Continuous improvements in diagnostics, surgical, and oncological treatment have led to an increased patient life expectancy [ 10 , 11 ]. Thus, for long-term surviving patients, the functional outcome and participation in sports are growing in importance [ 10 , 12 , 13 , 14 ]. While good-to-excellent functional outcomes are reported for megaprosthetic reconstructions around the proximal humerus, the data regarding reconstructions around the distal humerus are scarce, and the limited information available is often derived from small and heterogenous patient cohorts, involving primary and secondary malignancies, and/or different types of reconstruction and implant system [ 4 , 6 , 7 , 10 , 15 , 16 ].…”

Use of LARS for soft tissue function reconstruction during tumor-type hemi-shoulder replacement achieves a good prognosis: a retrospective cohort study

“…Limb salvage treatment of the proximal humerus is a major surgical challenge, as it involves both the repair of bone defects and the reconstruction of shoulder joint function [ 4 , 8 , 9 ]. The shoulder joint is the joint with the largest range of motion in the human skeleton, and the rotator cuff and joint capsule are critical to its stability.…”