DETERMINING SHOULDER RECONSTRUCTION STRATEGY AFTER RESECTION OF THE PROXIMAL HUMERUS FOR TUMOUR

Abstract

Purpose: Primary bone tumours located in the upper limb are mainly found in the proximal portion of the humerus. Tumour resection raises difficult situations due to the sacrifice of the cuff tendons. We propose a decision making scheme for determining the best reconstruction strategy.

Material and methods: This retrospective analysis was based on 35 cases (19 massive prostheses, ten composite prostheses, three inverted prostheses and three composite arthrodeses). All the clinical and radiographic data were reviewed to examine function, active motion, pain, and use of the upper limb in everyday activities.

Results: Massive humeral prostheses provided a technically simple solution but produced mediocre functional results: painless shoulder without active motion, but preservation of elbow and forearm function. Composite humeral prostheses (prosthesis + allograft) did not, in our experience provide any gain in function compared with massive prostheses. Allografts were resorbed after four to five years. Composite arthrodesis with allograft and vascularised fibular graft provided a mobile shoulder with a useful amplitude and a pain free joint. Results persisted. The inverted Delta prostheses (Grammont) covered with allografts and with preservation of the rotator cuff tendons offered an interesting alternative with functional results superior to arthrodesis and similar to those with shoulder prostheses implanted for degenerative disease. The persistence of the glenoid anchorage remains uncertain.

Conclusions: We use the following scheme for reconstruction of the proximal humerus. Resection of the proximal humerus with preservation of the deltoid in patients in good general health: inverted composite prosthesis. Resection of the proximal humerus without preservation of the deltoid in patients in poor general health: composite arthrodesis. Resection of the proximal humerus in patients in very poor general health when complex surgery with long post-operative care is not possible: massive prosthesis.