Prosthetic replacement of the proximal humerus after the resection of bone tumors

Abstract

Background and Objective: After using chemotherapy to treat patients with malignant bone tumors, 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: Between 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 Enneklng staging system, 7 osteosarcomas and 3 chondrosarcomas were at stage lib, and 3 GCTs and 2 chondrosarcomas were at stage lb. The patient with metastatic bone tumors reported severe pain. Results: 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°-35°, and circumgyrate angle was 18°-25°, with flexion 35°-90° and extension 25°-42°. According to the functional score developed by the International Society of Limb Salvage, scores ranged from 18 to 29 points, with an average of 24 points. Conclusions: Prosthetic 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 curative effects are presently uncertain.