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Proximal Humerus Reconstructions for Tumors

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

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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Author information

Authors and Affiliations

  1. Musculoskeletal Oncology, University of Miami Miller School of Medicine, Miami, FL, USA

    Benjamin K. Potter MD & Sheila C. Adams MD

  2. Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2A, Room 205, Washington, DC, 20307, USA

    Benjamin K. Potter MD

  3. Musculoskeletal Oncology & Joint Disorders, University of Miami Miller School of Medicine, Miami, FL, USA

    J. David Pitcher Jr. MD

  4. Orthopaedics and Pathology, Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA

    Theodore I. Malinin MD & H. Thomas Temple MD

Authors
  1. Benjamin K. Potter MD
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  2. Sheila C. Adams MD
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  3. J. David Pitcher Jr. MD
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  4. Theodore I. Malinin MD
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  5. H. Thomas Temple MD
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Correspondence to Benjamin K. Potter MD.

Additional information

This study was supported by a restricted educational grant from Stryker and one of the authors (HTT) is a paid consultant of Stryker.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Potter, B.K., Adams, S.C., Pitcher, J.D. et al. Proximal Humerus Reconstructions for Tumors. Clin Orthop Relat Res 467, 1035–1041 (2009). https://doi.org/10.1007/s11999-008-0531-x

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  • DOI: https://doi.org/10.1007/s11999-008-0531-x

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