Osteosarcoma of the Proximal Humerus: Long-Term Results With Limb-Sparing Surgery

Wittig, James C.; Bickels, Jacob; Kellar-Graney, Kristen; Kim, Frank H; Malawer, Martin M.

doi:10.1097/00003086-200204000-00021

Cited by 110 publications

(89 citation statements)

References 40 publications

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“…Several studies have focused on the proximal femur to try to understand the complex relationship of tendon-bone interfaces [16,27,33]. Osteoconductive scaffolds [53], metallic anchors for soft tissues [20], predetermined suture sites embedded in the metallic prostheses [50], and coating of the prostheses with novel materials [14,16,45], have been described to promote soft tissue ingrowth and improve function after limb salvage with endoprostheses. All of the surgical options for proximal humerus reconstruction have been associated with instability [25], recurrent dislocation [25,38], and overall poor function [36,38].…”

Section: Discussionmentioning

confidence: 99%

“…Wittig et al [50] analyzed the long-term survival and function and complications associated with limb-sparing surgery for 23 patients with osteosarcoma of the proximal humerus. In all patients, the endoprosthetic replacement was stabilized by static suspension (Dacron1 tapes) and dynamic suspension (muscle transfers).…”

Section: Discussionmentioning

confidence: 99%

“…All shoulders were stable and pain-free. The most common complication was a transient neuropraxia (n = 8) [50]. Gosheger et al [17] studied 69 megaprostheses implanted with the use of a polyethylene terephthalate (Trevira1) tube to support reconstruction of the capsule and soft tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported in detail the surgical technique for proximal humerus replacement using metallic endoprostheses after tumor excision [29,37,47,50,51]. As the humeral insertions for the rotator cuff complex and deltoid muscle are often involved in the resection, all of these techniques have stressed the importance of conserving a sufficient soft tissue envelope for reconstruction and the need to recreate sites for attachment of remaining structures.…”

Section: Methodsmentioning

confidence: 99%

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Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh

Marulanda

Henderson

Cheong

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction. Questions/purposes We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device. Methods We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13-43 months).Results There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43°(range, 15°-170°) and mean shoulder abduction of 38 (range, 15°-110°). The mean operative time was 121 minutes (range, 80-170 minutes) and the mean blood loss was 220 mL (range, 50-750 mL).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh

Marulanda

Henderson

Cheong

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…1 The close proximity to the humerus has led certain authors to recommend routine sacrifice of the deltoid muscle and axillary nerve for osteosarcomas of the proximal humerus. 2 Such a resection achieves the goal of a wide excision, but it can potentially compromise shoulder function after reconstruction.…”

mentioning

confidence: 99%

Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

Gupta¹,

Yasko²,

Lewis³

et al. 2009

Cancer

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BACKGROUND: The anatomy of the shoulder poses special challenges with regard to limb‐sparing surgery. Resection of the deltoid muscle is considered by some surgeons to be necessary to achieve adequate margins for osteosarcoma of the proximal humerus. However, this can compromise the functional results after reconstruction of the shoulder. The goal of the current study was to determine whether deltoid‐sparing resection can be safely performed for osteosarcoma of the proximal humerus. METHODS: Between 1978 and 2005, 23 consecutive patients with high‐grade nonmetastatic osteosarcoma of the proximal humerus underwent limb‐sparing surgery with preservation of the deltoid muscle. All patients received neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. The mean follow‐up was 90 months (range, 7 months‐279 months). RESULTS: The overall survival at 5 years was 77%. At the time of last follow‐up, 14 (61%) of 23 of patients were alive without evidence of disease. Three (13%) patients developed local recurrence. Two of these patients had poor responses to chemotherapy, with tumor necrosis of 50% and 70%. The third patient had a pathologic fracture of the humerus. Positive surgical margins were associated with local recurrence, and 2 of 4 patients with a positive surgical margin developed local recurrence (P = .01). CONCLUSIONS: Preservation of the deltoid muscle can be performed for carefully selected patients with osteosarcoma of the proximal humerus. Routine use of the procedure is not justified, because it may be associated with an elevated risk of recurrence. The risk of local recurrence appears to be related to positive surgical margins and possibly the percentage of tumor necrosis. Cancer 2009. © 2009 American Cancer Society.

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