Survival, Tumor Recurrence, and Function Following Shoulder Girdle Limb Salvage at 24 to 35 Years of Follow-up

Abstract

Limb salvage is the treatment of choice for malignant shoulder girdle tumors; however, there is a paucity of data examining the long-term outcome. The authors have previously reported on a cohort of patients at short- and mid-term follow-up. The purpose of this study was to report the long-term outcome of shoulder reconstruction in terms of oncological and functional outcome. The authors reviewed 53 patients who underwent a limb salvage procedure for treatment of a tumor of the shoulder girdle. At a mean of 28 years following the resection, 76% of surviving patients were contacted and administered functional outcome scores using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage (TESS). The 20-year survival and recurrence-free survival were 79% and 80%, respectively. Likewise, the 20-year revision survival was 75%, with a limb salvage rate of 94%. At last follow-up, the mean MSTS rating and TESS score were 75% and 85%, respectively, with 9 patients having improvement in their MSTS rating from the previous findings. Limb salvage following resection of shoulder girdle tumor resulted in acceptable means of oncological outcome and function. Some patients continued to experience improvements in functional outcome even at late (>20 years) follow-up. [ Orthopedics . 2019; 42(6):e514–e520.]

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

“…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.…”

Allograft prosthetic composite reconstruction using a reverse total shoulder arthroplasty for failed oncologic proximal humerus reconstruction

“…Endoprostheses and allograft prosthetic composites (APC) have become the mainstay of reconstruction options following resection of a proximal humeral bone tumor 1–14 . These techniques were developed to provide a stable platform for elbow, hand, and wrist function; however, historically shoulder motion and function were limited.…”

“…These techniques were developed to provide a stable platform for elbow, hand, and wrist function; however, historically shoulder motion and function were limited. Currently, endoprosthetic reconstruction of the proximal humerus is commonly performed due to its low complication rate, shorter operative times, and ease of reconstruction 1–12 . The reported rate of failure of an upper extremity endoprosthesis or APC is less than 20%, and the most common failure modes include soft‐tissue insufficiency causing subluxation or instability, as well as infection 3,13 …”

Humeral stress shielding following cemented endoprosthetic reconstruction: An under‐reported complication?

“…Limb‐salvage surgery is pursued whenever possible for patients with oncologic processes in the upper extremity. Although limb‐salvage surgery is the treatment of choice, it is known to be technically challenging 1–13 . Endoprosthetic replacement of the proximal humerus has become a reconstructive technique of choice due to the low complication rate and the relative ease of reconstruction 4–13 .…”

“…Although limb-salvage surgery is the treatment of choice, it is known to be technically challenging. [1][2][3][4][5][6][7][8][9][10][11][12][13] Endoprosthetic replacement of the proximal humerus has become a reconstructive technique of choice due to the low complication rate and the relative ease of reconstruction. [4][5][6][7][8][9][10][11][12][13] The reported rate of failure of an upper extremity endoprosthesis is 17% for any reason, with structural failure (Henderson Type 3; periprosthetic or prosthetic fracture or deficient osseous supporting structure) occurring in 0.84%-1.1% of patients.…”