Treatment of malignant tumors of the proximal humerus with allograft-prosthesis composite reconstruction

Abstract

Malignant tumors of the proximal humerus are challenging to treat. Reconstruction with a metallic implant or allograft is the most common method, but each has known risks and frequent complications. Allograft-prosthesis composite reconstruction has not been widely used and may avoid problems posed by metal prostheses or allografts used alone. Six patients with malignant tumors of the proximal humerus were treated with allograft-prosthesis composite reconstruction after excision of the intra-articular tumor. Outcomes were assessed by use of the Disabilities of the Arm, Shoulder and Hand questionnaire; the Short Form 36 (SF-36) Health Survey; and the American Shoulder and Elbow Surgeons Shoulder Assessment Form. Preoperative and postoperative scores at a mean of 55 months were compared. Disability increased after surgery based on the Disabilities of the Arm, Shoulder and Hand questionnaire and SF-36, although disability appeared to decrease with time. The mean mental component score on the SF-36 showed continued improvement with time after surgery. One asymptomatic nonunion was repaired, and painful loosening developed in one patient, requiring revision at 45 months. Allograft-prosthesis composite reconstruction is a safe method for treating some malignant tumors of the proximal humerus, providing stable reconstruction and preserving function of the shoulder joint.