Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review

Abstract

Background Tumors of the appendicular skeleton commonly affect the proximal humerus, but there is no consensus regarding the best reconstructive technique after proximal humerus resection for tumors of the shoulder. Questions/purposes We wished to perform a systematic review to determine which surgical reconstruction offers the (1) best functional outcome as measured by the Musculoskeletal Tumor Society (MSTS) score, (2) longest construct survival, and (3) lowest complication rate after proximal humerus resection for malignant or aggressive benign tumors of the shoulder. Methods We searched the literature up to June 1, 2013, from MEDLINE, EMBASE, and the Cochrane Library. Only studies reporting results in English, Dutch, or German and with followups of 80% or more of the patients at a minimum of 2 years were included. Twenty-nine studies with 693 patients met our criteria, seven studies (24%) were level of evidence III and the remainder were level IV. Studies reported on reconstruction with prostheses (n = 17), osteoarticular allografts (n = 10), and allograftprosthesis composites (n = 11). Owing to substantial heterogeneity and bias, we narratively report our results. Results Functional scores in prosthesis studies ranged from 61% to 77% (10 studies, 141 patients), from 50% to 78% (eight studies, 84 patients) in osteoarticular graft studies, and from 57% to 91% (10 studies, 141 patients) in allograftprosthesis composite studies. Implant survival ranged from 0.38 to 1.0 in the prosthesis group (341 patients), 0.33 to 1.0 in the osteoarticular allograft group (143 patients), and 0.33 to 1.0 in allograft-prosthesis group (132 patients). Overall complications per patient varied between 0.045 and 0.85 in the prosthesis group, 0 and 1.5 in the osteoarticular graft group, and 0.19 and 0.79 in the prosthesis-composite graft group. We observed a higher fracture rate for osteoarticular allografts, but other specific complication rates were similar. Conclusions Owing to the limitations of our systematic review, we found that allograft-prosthesis composites and prostheses seem to have similar functional outcome and survival rates, and both seem to avoid fractures that are observed with osteoarticular allografts. Further collaboration in the field of surgical oncology, using randomized controlled trials, is required to establish the superiority of any particular treatment. Electronic supplementary material The online version of this article

Allograft reconstruction of the humerus: Complications and revision surgery

“…However, our previous review of the literature and the published experience from our group, report a comparable rate of infection in the proximal humerus between endoprostheses, osteoarticular allografts, and APCs. We found a higher complication rate and need for revision with the use of osteoarticular allografts in the proximal humerus due to a higher rate of fractures of the allograft instead of infection . The vast majority of the literature on massive allograft reconstruction of the humerus focuses on the proximal humerus and is limited by small sample sizes.…”

“…The humerus is a relatively common location for tumors of the bone . Several options for reconstruction after resection are available depending on the location of the tumor . Alternatives for mobile reconstruction include endoprostheses (EP), allograft‐prosthesis composites (APCs), and osteoarticular/intercalary allograft reconstruction; each of these techniques having its advantages and disadvantages.…”

Reliability and Validity of a Japanese-language and Culturally Adapted Version of the Musculoskeletal Tumor Society Scoring System for the Lower Extremity

“…Extirpation of tumor tissue is expected to cause some degree of functional impairment; therefore, efforts should be made to decrease such impairment. Studies have reported on the functional outcomes of impairments on musculoskeletal tumor treatment [9,10,14,16,17,19,21].…”

“…Since then, this system has been used in numerous studies to evaluate functional outcomes [9,10,14,16,17,19,22], making it one of the most widely used functional evaluation tools. The original scoring system was written in English and subsequently has been translated into Brazilian Portuguese and Japanese.…”

Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis

“…Options following resection include allograft reconstruction, arthroplasty, and definitive resection with flail shoulder/resection arthroplasty . Hemiarthroplasty and allograft prosthetic composite with hemiarthroplasty have been the workhorse reconstruction with low complication rates and below shoulder level function . However, there are typically substantial functional deficits associated with this reconstruction .…”