Functional Outcomes and Complications After Oncologic Reconstruction of the Proximal Humerus

Nota, Sjoerd; Teunis, Teun; Kortlever, Joost T.P.; Ferrone, Marco; Ready, John E.; Gebhardt, Mark C.; Raskin, Kevin A.; Hornicek, Francis J.; Schwab, Joseph H.; Calderón, Santiago Lozano

doi:10.5435/jaaos-d-16-00551

Cited by 33 publications

(30 citation statements)

References 9 publications

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“…Most patients experienced one or more major complications such as caput humeri absorption or fracture; thus, the abductor mechanism was disrupted in almost all of these patients. Although excellent long-term outcomes were rare in our series, a flail shoulder is often the best alternative for the patient who does not need to use the hand in space; the same was reported by other authors [7][8][9][10][11][12][13][14][15][16][17]23]. We also find that functions of the elbow, wrist, and hand remained in a flail limb and can meet the requirements of daily life with the help of an orthotic or the contralateral hand.…”

Section: Discussionsupporting

confidence: 83%

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

et al. 2020

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Background: The proximal humerus is one of the most common sites of primary or metastatic malignant tumors. Reconstruction of the shoulder after tumor resection is controversial and challenging. When intra-articular resection is performed, biological reconstruction (osteoarticular allograft and autologous bone implantation) may be the first choice rather than prosthetic reconstruction. Objective: To observe the mid-to long-term effects of oncologic, reconstructive, and functional outcomes of two different biological reconstruction methods for resection of humerus osteosarcoma involving caput humeri. Methods: This was a retrospective study of 13 consecutive patients who underwent humeral reconstruction of osteosarcoma including caput humeri using osteoarticular allograft (n = 7) and tumor bone inactivated and reimplantation (TBIR, n = 6) in our clinic between 2007 and 2017. Patients' general information, resection and reconstruction techniques, oncological and functional outcomes, and complications were collected and evaluated. Different complications of implantations were compared and analyzed for the different biological methods. Results: The study included ten males and three females with an average age of 19.15 years. The operation time was about 3.65 h with an average blood loss of 631 ml. The resection tumor bones were 13-45 cm (23.54 cm on average). The mean follow-up period was 5.27 years. The shoulder movement was 10-70°(average, 44.00°) in abduction, 0-30°(average, 14.17°) in flexion, and 0-20°(average, 11.90°) in extention at the last follow-up. The complications included fracture in four TBIR patients and two allograft patients with an average of 2.67 years postoperation. Fracture rate was higher and appeared time was earlier in TBIR patients than in allograft patients (p = 0.04); caput humeri absorption occurred in all seven allograft patients and three TBIR patients at an average of 3.10 years after surgery; severe graft bone resorption appeared in five TBIR patients and two allograft patients at an average of 2.57 years of follow-up. Conclusions: Humerus biological reconstruction involving caput humeri was associated with a high complication rate and acceptable limb function in the mid to long term. New combined biological methods should be explored and adopted in the future.

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Section: Discussionsupporting

confidence: 83%

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

et al. 2020

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“…However, Wang et al, who found a much lower complication rate (33%), concluded that functional outcomes were better with allograft reconstruction. Nota et al found similar functional outcomes and no statistically significant difference in survival among the groups.…”

Section: Discussionmentioning

confidence: 89%

Allograft reconstruction of the humerus: Complications and revision surgery

Teunissen

Massier

Raskin

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Allograft reconstruction of the humerus after resection is preferred by many because of bone stock restoration and biologic attachment of ligaments and muscles to the allograft, theoretically obtaining superior stability and functionality. Our aim was to assess the prevalence of complications and the incidence and etiology for revision surgery in humeral allograft reconstructions. Methods We included patients 18 years and older who underwent wide resection and allograft reconstruction of the humerus for primary and metastatic lesions at our institution between 1990 and 2013. Our primary outcome measures were complications and revision surgery. We used competing risk regression to assess allograft survival. Results Of the 84 patients we included, 47 patients (51%) underwent allograft reconstructions of the proximal humerus, 30 (36%) intercalary, and seven (8%) of the distal humerus. Fifty‐one patients (61%) had at least one complication after surgery. Eighteen patients (21%) underwent revision surgery. The 5‐year allograft survival was 71%. Conclusion Although allograft reconstructions of the humerus are a valuable option in the orthopedic oncologist's armamentarium, surgeons should mind the accompanying complication rates. Allograft fractures seem to be the main issue for proximal and distal allografts, often leading to revision surgery. Intercalary allografts are mostly troubled by nonunions.

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“…19,[20][21][22][23][24] Five investigations comparing alternative reconstructive methods detected no significant TESS differences. [25][26][27][28][29] Moreover, Jones highlighted that TESS could not distinguish between resections of the anterior compartment that involved or spared the femoral and sciatic nerves. 30 In contrast, Davidge and Griffin identified that more extensive resections had poorer functional outcomes.…”

Section: Toronto Extremity Salvage Scorementioning

confidence: 99%

“…One study concluded that patients undergoing partial rather than total scapulectomy had less QOL impairments while the other evaluated the effectiveness of proximal humerus reconstruction and found no significant differences between osteoarticular allografts, endoprosthesis and allograft prosthetic composites. 27,52 Wilke compared limb salvage and amputation and found that while both had significantly worse function, limb salvage patients experienced lower rates of depression and sleep disturbance compared to the general U.S. population. 53…”

Section: Toronto Extremity Salvage Scorementioning

confidence: 99%

The need for improved patient reported outcome measures in patients with extremity sarcoma: a narrative review

Blight

Choong

2021

ANZ Journal of Surgery

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Background: Extremity sarcoma causes impairments to functionality and quality of life. Patient-reported outcome measures (PROMS) assess patient perspectives relating to domains of health and quality of life. Methods: To describe PROMs utilised in extremity sarcoma, the available literature was screened for studies that utilised PROMs to evaluate outcomes in extremity sarcoma following surgery. Results: Seventy articles met eligibility criteria; six PROMs were identified. The Toronto Extremity Salvage Score, The Short-Form 36, The EORTC QLQ-C30, The Disabilities of the Arm, Shoulder and Hand questionnaire, the Reintegration to Normal Living index and the Patient-Reported Outcomes Measurement Information System. Most sarcoma patients score well in these tools, with bone sarcoma, and extent of resection being predictors of poor outcomes. Conclusion: TESS is the only sarcoma-specific PROM, and though a valid assessment of functionality, it has difficulty differentiating patients with minor functional impairments. The absence of a disease-specific measure of health is concerning, as generic tools do not account for the unique experiences sarcoma patients face and may impair their accuracy in analysing intervention effectiveness. MethodsA MEDLINE database search was conducted on 18 August 2020, abstracts and full texts were screened against the following criteria: PopulationUpper and lower extremity sarcoma patients treated with surgery. OutcomePreviously validated PROMs. Studies considering paediatricspecific PROMs and patients with non-extremity sarcoma were excluded. Study typeCase studies, validation of non-PROM measures, and publications unavailable in English were excluded. To allow thorough analysis

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Functional Outcomes and Complications After Oncologic Reconstruction of the Proximal Humerus

Abstract: All three articular oncologic shoulder reconstructions were comparable in terms of function. This large series confirms a higher fracture rate in OAs, which explains the observed higher revision rate and apparent lower survival rate in this subgroup.

Cited by 33 publications

References 9 publications

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

Allograft reconstruction of the humerus: Complications and revision surgery

The need for improved patient reported outcome measures in patients with extremity sarcoma: a narrative review

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