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.
Highlights
The proximal humerus is a common location for both primary and metastatic bone tumors
Hemiarthroplasty had relatively few articles dedicated to its use in tumor reconstruction, but likely is more widely used for humeral head lesions, in metastatic scenarios
It should be noted that the functional scores between reconstruction methods are similar, there is a wide spectrum of post-resection/pre-reconstruction bone and soft tissue compromise
Summary
The proximal humerus is a common location for both primary and metastatic bone tumors. Numerous reconstruction and stabilization options after surgical management exist including allograft, alloprosthetic composite (APC), megaprosthesis, and more recently, reverse shoulder arthroplasty (RSA). The main goals of reconstruction are to restore function and limit complications. Tumor characteristics, and anatomic involvement are important factors. 204 The Open Orthopaedics Journal, 2017, Volume 11 to consider when selecting the optimal reconstruction. There is no consensus on the ideal method of reconstruction. There are numerous case series, but there is a lack of high-level comparative evidence between different options. The purpose of this study was to extensively review the existing literature
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