What is the Optimal Reconstruction Option after the Resection of Proximal Humeral Tumors? A Systematic Review

Abstract

Purpose:The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction.Methods:A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus.Results:A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%).Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA.Discussion:Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.

Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis

“…Surgical management of tumors of the proximal humerus can prolong and improve the quality of patients’ lives . The primary focus of surgical management is based in sound oncologic resection principles.…”

“…In most cases, ensuring a complete resection will optimize patient survival as well as long‐term function . Until relatively recently, reconstruction of the resulting shoulder was limited to hemiarthroplasty or allograft prosthetic composites . Recent advances in the design of reverse total shoulder arthroplasty components has facilitated oncologic reconstructions .…”

“…The proximal humerus is the third most common location for bone and soft tissue tumors, and these tumors pose surgical and reconstructive challenges. Options following resection include allograft reconstruction, arthroplasty, and definitive resection with flail shoulder/resection arthroplasty . Hemiarthroplasty and allograft prosthetic composite with hemiarthroplasty have been the workhorse reconstruction with low complication rates and below shoulder level function .…”

“…Options following resection include allograft reconstruction, arthroplasty, and definitive resection with flail shoulder/resection arthroplasty. 2 Hemiarthroplasty and allograft prosthetic composite with hemiarthroplasty have been the workhorse reconstruction with low complication rates and below shoulder level function. 3 However, there are typically substantial functional deficits associated with this reconstruction.…”

“…9 Until relatively recently, reconstruction of the resulting shoulder was limited to hemiarthroplasty or allograft prosthetic composites. 2,6 Recent advances in the design of reverse total shoulder arthroplasty components has facilitated oncologic reconstructions. 6 We believe patient outcome, both in terms of pain relief and function,…”