Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction

Abstract

The purpose of this study was to compare the outcome, complications and survival of the three most commonly used surgical reconstructions of the proximal humerus after transarticular tumour resection. Between 1985 and 2005, 38 consecutive proximal humeral reconstructions using allograft-prosthesis composite (n = 10), osteoarticular allograft (n = 13) or a modular tumour prosthesis (n = 14) were performed in our clinic. The mean follow-up was ten years (1–25). Of these, 27 were disease free at latest follow-up (mean 16.8 years) and ten had died of disease. The endoprosthetic group presented the smallest complication rate of 21% (n = 1), compared to 40% (n = 4) in the allograft-prosthesis composite and 62% (n = 8) in the osteoarticular allograft group. Only one revision was performed in the endoprosthetic group, in a case of shoulder instability. Infection after revision (n = 3), pseudoarthrosis (n = 2), fracture of the allograft (n = 3) and shoulder instability (n = 4) were the major complications of allograft use in general. Kaplan-Meier analysis showed a significantly better implant survival for the endoprosthetic group (log-rank p = 0.002). At final follow-up the Musculoskeletal Tumour Society scores were an average of 72% for the allograft-prosthetic composite (n = 7, median follow-up 17 years), 76% for the osteoarticular allograft (n = 3, 19 years) and 77% for the endoprosthetic reconstruction (n = 10, 5 years) groups. An endoprosthetic reconstruction after transarticular proximal humeral resection resulted in the lowest complication rate, highest implant survival and comparable functional results when compared to allograft-prosthesis composite and osteoarticular allograft use. We believe that the surgical approach that best preserves the abductor mechanism and provides sufficient surgical exposure for tumour resection contributed to better functional results and glenohumeral stability in the endoprosthetic group.

Proximal humerus allograft prosthetic composites: technique, outcomes, and pearls and pitfalls

“…At an average follow-up of 10 years, 27 of the 38 patients were disease free [31]. Contrary to Potter, the authors found lower MSTS scores in APC reconstruction patients (72 %) than in osteoarticular allograft patients (76 %) and endoprosthesis patients (77 %).…”

“…van de Sande et al [31] reported comparative outcomes in 10 patients treated with allograft prosthetic composites, 13 with osteoarticular allografts, and 14 with modular tumor prosthesis reconstructions. At an average follow-up of 10 years, 27 of the 38 patients were disease free [31].…”

“…Contrary to Potter, the authors found lower MSTS scores in APC reconstruction patients (72 %) than in osteoarticular allograft patients (76 %) and endoprosthesis patients (77 %). The authors recommended endoprosthetic reconstruction because of a lower complication rate and comparable functional scores to osteoarticular allografts [31].…”

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

“…In case of missing MSTS score standard deviations or baseline characteristics, we contacted the corresponding authors; of the contacted authors of 19 studies [1,6,9,12,16,17,19,25,27,31,36,43,45,47,50,56,[60][61][62], 13 replied [1,6,9,16,17,27,31,36,43,45,50,56,61] and seven were able to provide us with the requested additional data [6,9,17,27,36,45,56]. We regarded autoclaved autograft and allograft bone combined with a prosthesis as allograft-prosthesis composites.…”

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].…”