Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

Abstract

Background: The proximal humerus is one of the most common sites of primary or metastatic malignant tumors. Reconstruction of the shoulder after tumor resection is controversial and challenging. When intra-articular resection is performed, biological reconstruction (osteoarticular allograft and autologous bone implantation) may be the first choice rather than prosthetic reconstruction. Objective: To observe the mid-to long-term effects of oncologic, reconstructive, and functional outcomes of two different biological reconstruction methods for resection of humerus osteosarcoma involving caput humeri. Methods: This was a retrospective study of 13 consecutive patients who underwent humeral reconstruction of osteosarcoma including caput humeri using osteoarticular allograft (n = 7) and tumor bone inactivated and reimplantation (TBIR, n = 6) in our clinic between 2007 and 2017. Patients' general information, resection and reconstruction techniques, oncological and functional outcomes, and complications were collected and evaluated. Different complications of implantations were compared and analyzed for the different biological methods. Results: The study included ten males and three females with an average age of 19.15 years. The operation time was about 3.65 h with an average blood loss of 631 ml. The resection tumor bones were 13-45 cm (23.54 cm on average). The mean follow-up period was 5.27 years. The shoulder movement was 10-70°(average, 44.00°) in abduction, 0-30°(average, 14.17°) in flexion, and 0-20°(average, 11.90°) in extention at the last follow-up. The complications included fracture in four TBIR patients and two allograft patients with an average of 2.67 years postoperation. Fracture rate was higher and appeared time was earlier in TBIR patients than in allograft patients (p = 0.04); caput humeri absorption occurred in all seven allograft patients and three TBIR patients at an average of 3.10 years after surgery; severe graft bone resorption appeared in five TBIR patients and two allograft patients at an average of 2.57 years of follow-up. Conclusions: Humerus biological reconstruction involving caput humeri was associated with a high complication rate and acceptable limb function in the mid to long term. New combined biological methods should be explored and adopted in the future.

Comparative efficacy of intraoperative extracorporeal irradiated and alcohol-inactivated autograft reimplantation for the management of osteosarcomas—a multicentre retrospective study

“…Alcohol-inactivated bone requires a longer time to revascularize and integrate with the surrounding bone, so bone healing occurs over a prolonged period after surgery. New combined biological methods should be explored and adopted in the future [38].…”

Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management

“…Aponte-Tinao et al [ 32 ], albeit praising the good overall results of this technique, described among their shoulder graft reconstructions a risk of failure that amounted to 23%. Comparable rates were shown also by DeGroot et al (22%) [ 51 ], Jamshidi et al (22%) [ 52 ], and Ogink et al (23%) [ 53 ]; others had even higher rates, such as Mourikis et al (33%) [ 40 ], Yao et al (38%) [ 54 ], or Potter et al (29%) [ 30 ]. Potter et al pointed an overall success lower than the ones achieved by the same authors using other reconstructive approaches.…”

“…Another concern associated with the use of allografts is their relatively high risk of postoperative complications. Unfortunately, the use of osteoarticular allografts has been often associated with high rates of local complications such as chondrolysis, subchondral collapse, and implant fractures [ 9 , 13 , 18 , 23 , 24 , 28 – 35 , 40 , 51 , 54 , 55 ]. These adverse events often require revision surgery, leading to a significant decrease in terms of implant [ 30 ].…”

“…Implant fractures are among the most feared major complications that might occur after graft surgery (8–53%), being one of the main reasons for its failures [ 23 , 28 , 30 , 40 , 54 ]. In their population, Bus et al [ 56 ] found that proximal humerus implants in particular had a significantly higher incidence of fractures compared to other anatomical districts.…”

Outcomes of modular endoprosthesis reconstruction versus cement spacer reconstruction following resection of proximal humeral tumors

“…Limb salvage surgery rather than amputation has become the ideal management option for malignant tumors of the proximal humerus, providing functional and cosmetic benefits [ 24 , 25 ]. Several reconstructive options are available following tumor resection, including autologous grafts, osteoarticular allografts, endoprosthesis, allograft–prosthesis composite, or nail cement spacer [ 7 , 9 , 16 , 26 ].…”