Abstract
SummaryBackgroundThe aim of the study was to assess (1) sports activity, (2) sports involving the upper extremities, (3) functional outcome and (4) sports-related complications of long-term survivors of primary malignant bone tumors of the proximal humerus.MethodsA total of 18 patients with an endoprosthetic reconstruction for primary malignant bone sarcoma of the proximal humerus (8 male, 10 female, mean age 19.9 ± 8.4 years, range 7.8–37.4 years) with an average follow-up of 18.1 ± 7.4 years (range 6.7–29.8 years) were included. The type of sport, frequency, duration of each sport session and the University of California, Los Angeles (UCLA) activity score were assessed before surgery, at 1 year, 3 years and at the latest follow-up. Functional outcome was assessed by the Toronto extremity salvage score (TESS).ResultsThe mean UCLA activity score decreased from 8.0 (±1.3, range 5–9) preoperative to 4.2 (±1.7, range 3–8) at 1‑year follow-up (p < 0.05). After 3 years it increased to 5.1 (±1.75, range 3–8) and further to 7 (±1.8, range 4–9) at the last follow-up. The mean postoperative TESS was 80.8 (±6.4, range 75.7–91.4) at the latest follow-up. Patients who were initially more active without reconstruction including a synthetic mesh were more likely to develop soft tissue complications accompanied by proximal endoprothesis migration.ConclusionPatients with a modular endoprosthetic reconstruction of the humerus following primary bone sarcoma resume participation in sports. Regarding the low incidence of periprosthetic infections, utilization of a synthetic mesh for reconstruction to prevent soft tissue complications in active patients should be considered.
Highlights
The proximal humerus is the third most common site of primary bone sarcomas [1]
Of the remaining 61 patients 19 had a subsequent amputation of the affected limb due to infection, local recurrence, failure of the prosthesis or oncological complications
The mean UCLA activity score decreased from a mean preoperative score of 8.0 (±1.3, range 5–9) to 4.2 (±1.7, range 3–8) (p < 0.05) 1 year postoperatively
Summary
Endoprosthetic reconstruction is a successful treatment option for limb reconstruction after bone tumor resection or metastatic disease of the humerus [2,3,4,5,6]. Adequate en bloc resection of the tumor is often accompanied by pronounced loss of soft and bone tissues. These procedures result in a loss of function of the involved extremity [7]. Chemotherapy has a negative impact on metabolic function and muscle strength, resulting in prolonged rehabilitation [8, 9]. Regular exercise positively influences the cardiovascular system, pulmonary function and muscle strength in cancer survivors [8, 9, 11]
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