Endoprosthetic replacement for tumors of the proximal humerus

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Abstract

Background

The proximal humerus is one of the primary sites of tumors. Amputation of the upper limb is highly mutilating and artificial limbs provide limited function and poor cosmesis. For these reasons, limb-preserving techniques were established. The most important aspect of limb-salvage surgery is to preserve elbow and hand function after excision of tumors of the proximal humerus, although the shoulder may remain flail, with a limited active range of movement. Endoprosthetic replacement of the proximal humerus is a well-established procedure in salvage of the upper limb that provides a reasonable shoulder function with maintained excellent elbow and hand function.

Patients and methods

Ten patients were included in this case-series study. According to the staging system of Enneking and colleagues, they were classified as having eight primary bone tumors; accordingly, there were six cases graded as stage IIB, two cases graded as IB, and two cases graded as solitary metastasis at the proximal humerus. Wide resection was carried out, followed by reconstruction by a modular replacement endoprosthetic system. The mean age of the patients was 36 years (ranging from 17 to 54 years). The follow-p period of the study ranged from 42 to 96 months, with a mean of 61 months.

Results

Excellent functional outcomes were achieved in seven patients at final evaluation, with a mean of 85.5%. Three patients died because of disease progression and were excluded from the functional evaluation. There were no local recurrences, prosthetic instability, dislocation, or infection. Two patients developed radial nerve palsy, one showed spontaneous improvement, and the second showed improvement after the release of adhesions. None of the patients required any revision surgery.

Conclusion

The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of a tumor at the proximal humerus represents a major progress that provides a stable functional spacer after surgery. It has also obviated the need for prolonged immobilization as in cases of biological reconstruction. It results in a low complication rate and immediate stability, which facilitates normal functioning of the elbow and hand.

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