Reconstructive Surgery in Primary Malignant and Aggressive Benign Bone Tumor of the Proximal Humerus

Abstract

Primary malignant bone tumors of the proximal humerus have traditionally been treated by forequarter amputation. However, with the increased interest in limb salvage operations, efforts have been made to improve reconstructive surgery and some methods have become available for tumor control and preservation of a useful distal limb. This report describes three reconstructive techniques used for reconstruction of the humerus following primary tumor excision. We followed 11 patients treated by reconstructive surgery following tumor excision for primary malignant and aggressive benign bone tumors in the proximal humerus. The average follow-up period was 35.6 months. The histologic diagnosis included osteosarcoma (9), chondrosarcoma (1) and giant cell tumor (1). The options for reconstructive surgery following tumor excision were six prosthetic arthroplasties with low heat treated autobone, four arthroplasties with Ender nail and bone cement, and one arthroplasty with custom-made tumor prosthesis. We performed a retrospective analysis regarding functional status, as well as local recurrence, distant metastasis and complication. The functional status at final follow-up averaged 16 points (53.3%) overall: 17 points (56.7%) in the six prosthetic arthroplasties with low heat treated autobone; 15 points (50.0%) in two of four arthroplasties with Ender nail and bone cement (the two others died); and 16 points (53.3%) in the one arthroplasty with custom-made tumor prosthesis. Local recurrence was not observed in any of the cases. The complications noted were one nonunion between reimplanted, low heat treated autobone and the normal distal humerus and two metal failures. Each of these techniques for reconstructive surgery resulted in a relatively good outcome, although somewhat better results were found in the case of prosthetic arthroplasty with low heat treated autobone.