Functional outcome following endoprosthetic reconstruction of the proximal humerus

Background

The proximal humerus is a common site for tumors, either metastatic or primary. Thus it is a frequent site of intervention in musculoskeletal oncology surgery. We looked at the use of endoprosthetic reconstructions in surgical intervention for tumors of the proximal humerus.

Methods

A review of our database from 1990 to 2005 revealed 83 proximal humeral endoprosthetic reconstructions following an intra-articular, deltoid muscle, and axillary nerve sparing resection. Medical records and radiographs were reviewed to determine shoulder range of motion, MSTS scores, and any complications. The median patient age was 55 years (range, 13-80). The mean follow-up was 30 months (range, 1-199).

Results

Mean active abduction was 41° (range, 10-90°) and mean active forward flexion was 42° (range, 5-115°). The mean MSTS score was 63% (range, 40-83%). Implant-related complications included 2 deep infections and 22 patients with proximal migration of the prosthesis. No prostheses loosened. Only 2 required removal (1 for infection and 1 for progression of metastatic disease).

Conclusions

A proximal humeral endoprosthesis provides a durable reconstruction with a relatively low complication rate. Although it provides a stable platform for elbow and hand function, actual shoulder function is limited.

Level of evidence

Level IV, Case Series, Treatment Study.

Keywords: Endoprosthesis, proximal humerus, musculolskeletal tumor, metastatic carcinoma, shoulder reconstruction