Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Mar 24;30(4):3571-3579.
doi: 10.3390/curroncol30040272.

Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases

Alessandro El Motassime  1 , Cesare Meschini  1   2 , Doriana Di Costa  1 , Giuseppe Rovere  1   2 , Maria Rosaria Matrangolo  1 , Fernando De Maio  3 , Pasquale Farsetti  3 , Antonio Ziranu  1   2 , Giulio Maccauro  1   2 , Raffaele Vitiello  1   2
Affiliations
Observational Study

Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases

Alessandro El Motassime et al. Curr Oncol. .

Abstract

(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of the most involved sites for metastases. Prosthetic replacement with modular megaprosthesis is one of the treatment choices, but there are several types of complications, such as problems with function and pain. The aim of our study is to assess functional outcomes and shoulder instability in the reconstruction of proximal humerus metastases. (2) Methods: This is a retrospective observational study. Twenty-eight patients, with proximal humerus metastases, admitted to the department of Orthopaedics and Traumatology of our University Hospital between 2014 and 2022 were recruited. Each patient underwent resection and prosthetic replacement surgery with modular megaprosthesis. Clinical evaluation was assessed through MSTS score, WOSI index, and DASH score. (3) Results: Twenty patients were included in the study. Fairly good results, especially regarding pain, function, and emotional acceptance, were obtained in all three tests: DASH, MSTS, and WOSI. Patients who reported shoulder instability actually have worse outcomes than those who report having stable shoulders. In addition, patients with a resection >10 cm have worse outcomes than those who had a resection of 10 cm. No significant differences were found between the deltopectoral approach group and the lateral approach group. (4) Conclusions: Reconstructive surgery with megaprosthesis of the proximal humerus in patients with metastases can be considered a treatment option, especially in patients with pathological fractures or injuries with a high risk of fracture and good life expectancy. This study shows how this type of surgery affects instability, but in terms of functionality, pain, and patient satisfaction, it gives satisfactory results.

Keywords: functional outcome; megaprosthesis; proximal humerus; shoulder.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
y.o. male affected by metastatic kidney tumor. Lateral approach resection was 10 cm. (a’,a’’) pre-op X-ray; (b) pre-op ct scan; (c) post-op X-ray; (d’,d’’) 6 months follow.
Figure 2
Figure 2
Stable vs. unstable patients. Reporting results of DASH, MSTS, and WOSI scores in patients who felt stable compared with those who felt instability in their shoulders.
See this image and copyright information in PMC

References

    1. Ferlauto H.R., Wickman J.R., Lazarides A.L., Hendren S., Visgauss J.D., Brigman B.E., Anakwenze O.A., Klifto C.S., Eward W.C. Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: A systematic review. J. Shoulder Elbow Surg. 2021;30:e647–e658. doi: 10.1016/j.jse.2021.06.004. - DOI - PubMed
    1. Gebhart M., Dequanter D., Vandeweyer E. Metastatic involvement of the humerus: A retrospective study of 51 cases. Acta. Orthop. Belg. 2001;67:456–463. - PubMed
    1. Rovere G., Meschini C., Piazza P., Messina F., Caredda M., De Marco D., Noia G., Maccagnano G., Ziranu A. Proximal humerus fractures treatment in adult patients with bone metastasis. Eur. Rev. Med. Pharmacol. Sci. 2022;26((Suppl. S1)):100–105. - PubMed
    1. Vitiello R., Bellieni A., Oliva M.S., Di Capua B., Fusco D., Careri S., Colloca G.F., Perisano C., Maccauro G., Lillo M. The importance of geriatric and surgical co-management of elderly in muscoloskeletal oncology: A literature review. Orthop. Rev. 2020;12((Suppl. 1)):8662. doi: 10.4081/or.2020.8662. - DOI - PMC - PubMed
    1. Ayvaz M., Cetik R.M., Bakircioglu S., Tokgozoglu A.M. Proximal Humerus Tumors: Higher-than-Expected Risk of Revision With Constrained Reverse Shoulder Arthroplasty. Clin. Orthop. Relat. Res. 2020;478:2585–2595. doi: 10.1097/CORR.0000000000001245. - DOI - PMC - PubMed

Publication types