[Prosthesis replacement of the proximal humerus after the resection of bone tumors].
OBJECTIVE
After chemotherapy was used to treat patients with malignant bone tumors in 1970s, amputation, which was the typical intervention in the 1980s, has been substituted with limb-sparing surgery. This article reported the surgical indications, operative methods, operative effects, and complications of prosthetic replacement of the proximal humerus after the resection of bone tumors.


METHODS
From April 2004 and December 2008, prosthetic replacement was performed in 18 patients with proximal humerus tumors, including 7 patients with osteosarcoma, 5 patients with chondrosarcoma, 3 patients with giant cell tumor (GCT) of the bone, 1 patient with GCT of the bone combined with an aneurysmal bone cyst, and 1 patient with metastatic bone tumors. Using the Enneking staging system, 7 osteosarcomas and 3 chondrosarcomas were at stage Ib, and 3 GCTs and 2 chondrosarcomas were at stage Ib. The patient with metastatic bone tumors reported severe pain.


RESULTS
The follow-up ranged 5-61 months (mean, 29 months) and showed that 1 patient with osteosarcoma died 19 months after surgery. Local recurrence presented in 1 patient with GCT, 1 patient had inner infection in the area of surgery, and 2 patients had shoulder subluxation after the operation. There was no prosthetic loosening in any patient. The abduction angle of the shoulder was 8 degrees-35 degrees, and circumgyrate angle was 18 degrees-25 degrees, with flexion 35 degrees-90 degrees and extension 25 degrees-42 degrees. According to the functional score developed by the International Society of Limb Salvage, scores ranged between 18 and 29 points, with an average of 24 points.


CONCLUSIONS
The prosthesis replacement for the patients with bone tumors in the proximal humerus is an appropriate procedure with satisfactory therapeutic outcomes; however, many complications should be noted and long-term therapeutic effect needs further investigations.
Shi
Si-Feng
SF
Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, People's Republic of China.
Dong
Yang
Y
Zhang
Chun-Lin
CL
Bao
Kun
K
Ma
Xiao-Jun
XJ
D000293:Adolescent; D000328:Adult; D019643:Arthroplasty, Replacement; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D006811:Humerus; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D019919:Prosthesis Implantation; D011859:Radiography; D016059:Range of Motion, Articular; D055815:Young Adult