Proximal Humerus Reconstructions for Tumors

The optimal method for reconstructing the proximal humerus in patients with tumors is controversial. To determine functional outcomes and complication rates after different types of reconstructions, we reviewed a consecutive series of 49 patients who underwent proximal humerus resection and osteoarticular allograft (17 patients), allograft-prosthetic composite (16), or endoprosthetic (16) reconstruction. Operative indications included primary malignancies (24 patients), metastatic disease (19), and benign aggressive disease (six). Implant revision was more common after osteoarticular reconstruction (five of 17) than after allograft-prosthetic composite (one of 16) or endoprosthetic (zero of 16) reconstructions. At a minimum followup of 24 months (median, 98 months; range, 24–214 months) in surviving patients, Musculoskeletal Tumor Society functional scores averaged 79% for the allograft-prosthetic composite, 71% for the osteoarticular allograft, and 69% for the endoprosthetic reconstruction cohorts. Shoulder instability was associated with abductor mechanism compromise and was more common after endoprosthetic reconstruction. Allograft fractures occurred in 53% of patients receiving osteoarticular allografts. We recommend allograft-prosthetic composite reconstruction for younger patients with primary tumors of bone and endoprosthetic reconstruction for older patients with metastatic disease. Because of the unacceptable complication rate, we do not recommend osteoarticular allograft reconstruction for routine use in the proximal humerus

Custom mega-prosthetic replacement for proximal humeral tumours

We used custom mega-prostheses in 57 patients with aggressive benign and malignant tumours of the proximal humerus. The most common tumour was osteosarcoma, followed by giant cell tumour and chondrosarcoma. We achieved extra-articular and wide resection margins in all primary malignant tumours and narrow margins in benign and metastatic tumours. Six patients died of disease, 4 patients developed local recurrences and 43 were continuously disease free at an average follow-up of 5.5 years (range 2–14.5 years). Five patients required revision replacements. The most common complications were proximal subluxation and aseptic loosening. Functional outcome was satisfactory in 78% of cases