Polyvalence des allogreffes massives dans le traitement de tumeurs de l?hum�rus proximal

Abstract

Endoprosthetic replacement (EPR) of the proximal humerus following tumour resection has resulted in proximal subluxation, pain, instability and poor function. Alternative reconstructive options to EPR include leaving the shoulder flail, insertion of a passive spacer and arthrodesis. Five patients were treated using massive cadaveric allografts as the method of reconstruction following tumour resection. The pathology was three osteosarcoma, one chondrosarcoma and one metastasis from a renal primary. The patients were evaluated clinically using the Musculoskeletal Tumour Society (MSTS) and Constant shoulder assessments. All four patients with primary tumours were alive and disease free at review after a median follow-up of 23 months (range 14–112). No patients suffered immediate complications. Three of the four patients were pain free. Function was limited, causing at least partial occupational restriction in three of four patients. Allograft remains a viable alternative to EPR in reconstruction following tumour resection. Costs are favourable, and patients gain good analgesia. Function is sacrificed (as it is in EPR), especially if tumour resection necessitates nerve sacrifice. In our patients, the allograft was used either as a passive spacer, arthrodesis or arthroplasty, demonstrating its versatility.