Functional outcome and quality of life following resection of the proximal humerus performed for musculoskeletal tumors and reconstruction done by four different methods

Abstract

Introduction The proximal humerus is a frequent site for both primary and secondary bone tumors. Several options are currently available to reconstruct the resected humerus, but there is no consensus regarding optimal reconstruction. The aim of this retrospective study was to compare the functional outcome, complications and patient compliance following four different types of reconstructive techniques. Material and methods The authors performed 90 proximal humerus resections due to primary and secondary bone tumors over the past 21 years. Four different procedures were performed for reconstruction following the resection: fibula autograft transplantation, osteoarticular allograft implantation, modular tumor endoprosthesis (hemiarthroplasty) and reconstruction of the defect with a reverse shoulder prosthesis-allograft composite. A retrospective analysis of the complications and patient’s physical status was performed. Functional outcome and life quality was evaluated by using the MSTS and SF-36 scores. Results The best range of motion was observed following arthroplasty with a reverse shoulder prosthesis-homograft composite followed by a fibula autograft reconstruction. Revision surgery was required due to major complications most frequently in the osteoarticular allograft group, followed by the reverse shoulder prosthesis-allograft composite group, the autologous fibula transplantation group; the tumor endoprosthesis hemiarthroplasty group had superior results regarding revision surgery (40, 25, 24 and 14% respectively). MSTS was 84% on average for the reverse shoulder prosthesis-allograft composite group, 70% for the autologous fibula group, 67% for the anatomical hemiarthroplasty group and 64% for the osteoartricular allograft group. Using the SF-36 questionnaire for assessment no significant differences were found between the four groups regarding quality of life. Discussion Based on the results of our study the best functional performance (range of motion and patient compliance) was achieved in the a reverse prosthesis-allograft combination group—in cases where the axillary nerve could be spared. The use of an osteoarticular allograft resulted in unsatisfying functional results and high complication rates, therefore we do not recommend it as a reconstructive method following resection of the proximal humerus due to either primary or metastatic bone tumors. Young patients who have good life expectancy but a small humerus or intramedullar cavity reconstruction by implantation of a fibula autograft is a good option. For patients with a poor prognosis (i.g. bone metastases) or in cases where the axillary nerve must be sacrificed, hemiarthroplasty using a tumor endoprosthesis was found to have acceptable results with a low complication rate. According to the MSTS and SF-36 functional scoring systems patients compliance was nearly identical following all four types of reconstruction techniques; the underlying cause may be the complexity of the shoulder girdle. However, we recommend the implantation of a reverse shoulder prosthesis-allograft whenever indication is appropriate, as it has been demonstrated to provide excellent functional outcomes, especially in young adults.

Proximal Humerus Reconstruction for Bone Sarcomas

“…This is especially important if the deltoid can be preserved; however, reconstructions can still be performed using a reverse APC when margins necessitate removal of a portion of or the entire deltoid and/or axillary nerve 50,51 . Additional series (Tables III and V) have also shown that rAPC offers the greatest improvements in functional outcomes with a reduction in complications that are typically associated with reconstruction 26,48,75,77 . Reverse APC reconstructions are not without their own complications.…”

The Systematic Review of Outcome After Reconstruction of the Proximal Humerus for Tumor Resection

“…Antal, et al (2023) 7 showed that six developed complications (24%) in the autologous fibula transplantation group. Four complications (40%) occurred in the group of 10 patients who received a massive osteoarticular allograft.…”

“…Functional Outcomes: Musculoskeletal Tumor Society (MSTS) score Antal, et al (2023) 7 showed that the best scores were found in the reverse shoulder prosthesis-bone allograft composite group, the score was 84%. Whereas MSTS score in the autologous fibula transplantation group was MSTS score was 70%.…”