Abstract
We used custom mega-prostheses in 57 patients with aggressive benign and malignant tumours of the proximal humerus. The most common tumour was osteosarcoma, followed by giant cell tumour and chondrosarcoma. We achieved extra-articular and wide resection margins in all primary malignant tumours and narrow margins in benign and metastatic tumours. Six patients died of disease, 4 patients developed local recurrences and 43 were continuously disease free at an average follow-up of 5.5 years (range 2–14.5 years). Five patients required revision replacements. The most common complications were proximal subluxation and aseptic loosening. Functional outcome was satisfactory in 78% of cases.
Résumé
Nous avons traité 57 malades avec une tumeur bénigne agressive ou une tumeur maligne de l’humérus proximal par résection et remplacement par prothèse massive sur mesure. La tumeur la plus commune était l’ostéosarcome suivi par la tumeur à cellules géantes et le chondrosarcome. Nous avons obtenus des résection extra — articulaires et larges dans toutes les tumeurs malignes et des résections marginales dans les tumeurs bénignes et métastatiques. Six malades sont morts de maladie, quatre malades ont développé des récidives locales et 43 étaient sans maladie à un suivi moyen de 5,5 (2–14,5) années. 5 malades ont nécessité des reprises prothétiques. Les complications les plus communes étaient la subluxation proximale et le descellement aseptique. Le résultat fonctionnel était satisfaisant dans 78% des cas.
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References
Asavamongkolkul A, Eckardt JJ, Eilber FR, Dorey FJ, Ward KG, Kelly CM, Wiraganowicz PZ, Kabo JM (1999) Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop Relat Res 360:207–220
Bos G, Sim F, Pritchard D, Shives T, Rock M, Askew L, Chao E (1987) Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res 224:178–191
De Wilde LF, Van Ovost E, Uyttendaele D, Verdonk R (2002) Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus. Rev Chir Orthop Reparatrice Appar Mot 88:373–378
Eckhardt, JJ, Eilber FR, Dorey FJ, Mirra JM (1985) The UCLA experience in limb salvage surgery for malignant tumors. Orthopedics 8:612–621
Enneking WF (1983) Musculoskeletal tumor surgery, vol.1. Churchill Livingstone, New York, pp 378–405
Enneking WF (1987) Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In Bristol–Myers/Zimmer Orthopaedic Symposium. Limb salvage in musculoskeletal oncology. Churchill Livingstone, New York, pp 626–639
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcomas. Clin Orthop 153:106–120
Fuhrmann RA, Roth A, Venbrocks RA (2000) Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus. J Cancer Res Clin Oncol 126:337–344
Gebhardt MC, Roth YF, Mankin HJ (1990) Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am 72:334–345
Getty PJ, Peabody TD (1999) Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am 81:1138–1146
Jensen KL, Johnston JO (1995) Proximal humeral reconstruction after excision of a primary sarcoma. Clin Orthop 311:164–175
Lord CF, Gebhardt MC, Tomford WW, Mankin HJ (1988) Infection in bone allografts—incidence, nature, and treatment. J Bone Joint Surg Am 70: 369–376
Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 77:1154–1165
Michael PL, Sam Kurutz BS (1999) Geometric analysis of commonly used prosthetic systems for proximal humeral replacement. J Bone Joint Surg Am 81:660–671
O’Connor MI, Sim FH, Edmund YS Chao (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78:1872–1888
Olsson E, Andersson D, Brostrom LA, Wallensten R, Nilsonne U (1990) Shoulder function after prosthetic replacement of the proximal humerus. Ann Chir Gynaecol 79:157–160
Peabody TD, Finn HA, Simon MA (1991) Allograft arthrodesis of the shoulder after extra-articular resection of malignant tumors of the proximal humerus. In: Brown KLB (ed) Complications of limb salvage. Prevention, management and outcome. International Symposium on Limb Salvage, Montreal, pp 589–592
Robertson DD, Yuan J, Bigliani LU, Flatow EL, Yamaguchi K (2000) Three-dimensional analysis of the proximal part of the humerus: relevance to arthroplasty. J Bone Joint Surg Am 82:1594–1602
Rodl RW, Gosheger G, Gebert C, Lindner N, Ozaki T, Winkelmann W (2002) Reconstruction of proximal humerus after wide resection of tumors. J Bone Joint Surg Br 84:1004–1008
Shin KH, Park HJ, Yoo JH, Hahn SB (2000) Reconstructive surgery in primary malignant and aggressive benign bone tumor of the proximal humerus. Yonsei Med J 41:304–311
Simon M (1989) Limb-salvage for osteosarcoma. In: Yamamuro T (ed) New developments for limb salvage in musculoskeletal tumors. Springer, New York, pp 71–72
Tomford WW (1995) Current concepts review. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77:1742–1754
Tomita K, Aotake Y, Sugihara M, Tsuchiya H (1989) Overall results and functional evaluation of limb salvage for osteosarcoma. In: Yamamuro T (ed) New developments for limb salvage in musculoskeletal tumors. Springer, New York, pp 53–57
Wada T, Usui M, Isu K, Yamawakii S, Ishii S (1999) Reconstruction and limb salvage after resection of malignant bone tumor of the proximal humerus—a sling procedure using free vascularised fibular graft. J Bone Joint Surg Br 81:808–813
Wittig JC, Bickels J, Lellar-Graney KL, Kim FH, Malawer MM (2002) Osteosarcoma of the proximal humerus: long-term results with limb sparing surgery. Clin Orthop Relat Res 397:156–176
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Mayilvahanan, N., Paraskumar, M., Sivaseelam, A. et al. Custom mega-prosthetic replacement for proximal humeral tumours. International Orthopaedics (SICO 30, 158–162 (2006). https://doi.org/10.1007/s00264-005-0029-z
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DOI: https://doi.org/10.1007/s00264-005-0029-z