Abstract
The humerus is primarily affected in approximately 10 % of patients by primary bone tumors. Furthermore, the proximal humerus is a preferred location of metastatic invasion for breast carcinoma and renal cell carcinoma. Limb salvage surgery is indicated for these patients if a functional limb remains after tumor resection and if the patient’s general condition permits surgery. For the shoulder, the majority of resections involve a type I or V according to Malawer’s classification. Restoration of shoulder function after proximal humeral resection for oncological reasons is still a challenge. In most oncological cases, resection of the rotator cuff is necessary to obtain eradication of the tumor. For these patients, reverse shoulder arthroplasty can provide durable midterm function. The location of the tumor determines whether a reversed arthroplasty in combination with a transfer of the latissimus dorsi and teres major muscle can be used to overcome the problem of insufficient external rotation strength after rotator cuff resection.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Unni K. Dahlin’s bone tumors: general aspects and data on 11,087 cases. 5th ed. Philadelphia: Lippincott-Raven; 1996.
Hansen B, Keller J, Laitinen M, Berg P, Skjeldal S, Trovik C, Nilsson J, Walloe A, Kalén A, Wedin R. The Scandinavian Sarcoma group skeletal metastasis register survival after surgery for bone metastases in the pelvis and extremities. Acta Orthop. 2004;75(S311):11–5.
Sorensen MS, Gregersen KG, Grum-Schwensen T, Hovgaard D, Petersen MM. Patient and implant survival following joint replacement because of metastatic bone disease. Acta Orthop. 2013;84(3):301–6. doi:10.3109/17453674.2013.788437.
Malawer MM, Meller I, Dunham WK. A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients. Clin Orthop Relat Res. 1991;267:33–44.
Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Meller I, Malawer MM. Limb-sparing resections of the shoulder girdle. J Am Coll Surg. 2002;194(4):422–35.
Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16(1):65–8.
Jacobs R, Debeer P, De Smet L. Treatment of rotator cuff arthropathy with a reversed delta shoulder prosthesis. Acta Orthop Belg. 2001;67(4):344–7.
Jarrett CD, Brown BT, Schmidt CC. Reverse shoulder arthroplasty. Orthop Clin North Am. 2013;44(3):389–408. doi:10.1016/j.ocl.2013.03.010.
De Wilde L, Boileau P, Van der Bracht H. Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment? Clin Orthop Relat Res. 2011. doi:10.1007/s11999-010-1758-x.
de Leest O, Rozing PM, Rozendaal LA, van der Helm FC. Influence of glenohumeral prosthesis geometry and placement on shoulder muscle forces. Clin Orthop Relat Res. 1996;330:222–33.
Gagey O, Hue E. Mechanics of the deltoid muscle. a new approach. Clin Orthop Relat Res. 2000;375:250–7.
Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy. 2003;19(10):1109–20. doi:10.1016/j.arthro.2003.10.030.
De Wilde L, Audenaert E, Barbaix E, Audenaert A, Soudan K. Consequences of deltoid muscle elongation on deltoid muscle performance: a computerised study. Clin Biomech (Bristol, Avon). 2002;17(7):499–505 doi:S0268003302000657 [pii].
De Wilde LF, Audenaert EA, Berghs BM. Shoulder prostheses treating cuff tear arthropathy: a comparative biomechanical study. J Orthop Res. 2004;22(6):1222–30. doi:10.1016/j.orthres.2004.03.010 doi:S0736026604000725 [pii].
Kaa AK, Jorgensen PH, Sojbjerg JO, Johannsen HV. Reverse shoulder replacement after resection of the proximal humerus for bone tumours. Bone Joint J. 2013;95(11):1551–5. doi:10.1302/0301-620x.95b11.31545.
Spross C, Ebneter L, Benninger E, Erschbamer M, Erhardt J, Jost B. Short- or long-stem prosthesis for intramedullary bypass of proximal humeral fractures with severe metaphyseal bone loss: evaluation of primary stability in a biomechanical model. J Shoulder Elbow Surg. 2013;22(12):1682–8. doi:10.1016/j.jse.2013.02.012.
Bickels J, Jelinek JS, Shmookler BM, Neff RS, Malawer MM. Biopsy of musculoskeletal tumors. Current concepts. Clin Orthop Relat Res. 1999;368:212–9.
McCann PA, Kapur RA, Sarangi PP. Reverse geometry shoulder replacement for proximal humeral metastases. J Bone Joint Surg. 2012; British Volume 94-B (SUPP XLII):16.
Redfern TR, Wallace WA, Beddow FH. Clavicular osteotomy in shoulder arthroplasty. Int Orthop. 1989;13(1):61–3.
Cuff D, Levy JC, Gutierrez S, Frankle MA. Torsional stability of modular and non-modular reverse shoulder humeral components in a proximal humeral bone loss model. J Shoulder Elbow Surg. 2011;20(4):646–51. doi:10.1016/j.jse.2010.10.026.
De Wilde LF, Poncet D, Middernacht B, Ekelund A. Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010;81(6):719–26. doi:10.3109/17453674.2010.538354.
Boileau P, Rumian AP, Zumstein MA. Reversed shoulder arthroplasty with modified L’Episcopo for combined loss of active elevation and external rotation. J Shoulder Elbow Surg. 2010;19(2 Suppl):20–30. doi:10.1016/j.jse.2009.12.011 doi:S1058-2746(09)00565-5 [pii].
De Wilde L, Boileau P, Van der Bracht H. Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment? Clin Orthop Relat Res. 2011;469(9):2489–95. doi:10.1007/s11999-010-1758-x.
Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89(2):292–300. doi:10.2106/jbjs.e.01310.
Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am. 2009;91(1):119–27. doi:10.2106/JBJS.H.00094 doi:91/1/119 [pii].
De Wilde LF, Van Ovost E, Uyttendaele D, Verdonk R. Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur. 2002;88(4):373–8.
De Wilde L, Sys G, Julien Y, Van Ovost E, Poffyn B, Trouilloud P. The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection. Acta Orthop Belg. 2003;69(6):495–500.
De Wilde L, Plasschaert F. Prosthetic treatment and functional recovery of the shoulder after tumor resection 10 years ago: a case report. J Shoulder Elbow Surg/Am Shoulder Elbow Surg [et al]. 2005;14(6):645–9. doi:10.1016/j.jse.2004.11.001.
De Wilde LF, Plasschaert FS, Audenaert EA, Verdonk RC. Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery. Clin Orthop Relat Res. 2005;430:156–62.
Teunis T, Nota SP, Hornicek FJ, Schwab JH, Lozano-Calderon SA. Outcome after reconstruction of the proximal humerus for tumor resection: a systematic review. Clin Orthop Relat Res. 2014. doi:10.1007/s11999-014-3474-4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Sys, G., Van Tongel, A., De Wilde, L. (2016). Proximal Humerus Tumors. In: Frankle, M., Marberry, S., Pupello, D. (eds) Reverse Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-20840-4_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-20840-4_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-20839-8
Online ISBN: 978-3-319-20840-4
eBook Packages: MedicineMedicine (R0)