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. 2009 Apr;467(4):1035-41.
doi: 10.1007/s11999-008-0531-x. Epub 2008 Sep 27.

Proximal humerus reconstructions for tumors

Benjamin K Potter  1 , Sheila C Adams, J David Pitcher Jr, Theodore I Malinin, H Thomas Temple
Affiliations

Proximal humerus reconstructions for tumors

Benjamin K Potter et al. Clin Orthop Relat Res. 2009 Apr.

Abstract

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.

Level of evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
The Kaplan-Meier implant survivorship estimate curves with revision for any reason as the end point show an apparent difference (p = 0.07) in revision rates at 5 years for OA (56%; 95% confidence interval, 26%–86%), compared with APC (91%; 95% confidence interval, 74%–100%) and EP (100%; 95% confidence interval, not applicable) reconstructions. Inverted triangles (OA), plus signs (APC), and solid circles (EP) along the curves represent patients censored owing to patient death or loss to followup.
See this image and copyright information in PMC

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