Functional outcomes and complications of reconstruction of the proximal humerus after intra-articular tumor resection.
OBJECTIVE
To evaluate functional outcomes and complications of reconstruction of the proximal humerus after intra-articular tumor resection.


METHODS
Twenty-five patients who underwent Malawer I type resection and reconstruction of the proximal humerus for treatment of malignant or invasive benign tumors from August 1999 to August 2005 were evaluated. A variety of reconstructive procedures, including modular tumor prosthesis, osteoarticular allograft, and allograft-prosthetic composite (APC), were performed after resection of tumor. Oncological and radiographic parameters were evaluated. The modified Musculoskeletal Tumor Society (MSTS) evaluation system was used to assess limb functional outcome.


RESULTS
The study group consisted of 10 male and 15 female patients, among which there were 20 malignant and 5 benign tumors. Restoration of shoulder function was achieved with a prosthesis in 6 patients, osteoarticular allograft in 12, and allograft-prosthesis composite in 7. At a mean of 48 months follow-up, 2 patients had died of disease. Two patients had local recurrence and 2 had metastatic disease. On the basis of the modified MSTS functional evaluation, the mean scores were 22.50 in the modular prosthesis group, 24.58 in the osteoarticular allograft group, and 27.00 in APC group, respectively. Joint instability and subluxation were serious complications affecting shoulder function in 10 patients.


CONCLUSIONS
Reconstruction of the proximal humerus is an option that provides good relief of pain and preserves manual dexterity. Functional outcomes are better for APC and allograft than for modular prosthesis, due to retention of the rotation cuff. Complications in the APC group were less than in the allograft one.
Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi'an, China. wangzhen@fmmu.edu.cn
Zhen
Z
Wang
Zheng
Z
Guo
Jing
J
Li
Xiang-dong
XD
Li
Hong-xun
HX
Sang
D000293:Adolescent; D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008223:Lymphoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009372:Neoplasms, Connective Tissue / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult