Reconstructive surgery in primary malignant and aggressive benign bone tumor of the proximal humerus

Primary malignant bone tumors of the proximal humerus have traditionally be en created by forequarter amputation. However, with che increased interest in limb salvage operations, efforts have been made co improve reconstructiv e surgery and some methods have become available for tumor control and pres ervation of a useful distal limb. This report describes three reconstructiv e techniques used for reconstruction of the humerus following primary tumor excision. We followed 11 patients created by reconstructive surgery follow ing 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 gian t cell tumor (1). The options for reconstructive surgery following tumor ex cision were six prosthetic arthroplasties with low heat created autobone, f our arthroplasties with Ender nail and bone cement, and one arthroplasty wi th custom-made tumor prosthesis. We performed a retrospective analysis rega rding functional status, as well as local recurrence, distant metastasis an d complication. The functional status at final follow-up averaged 16 points (53.3%) overall: 17 points (56.7%) in the six prosthetic arthroplasties wi th low heat treated autobone; 15 points (50.0%) in two of four arthroplasti es 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 recur rence was not observed in any of the cases. The complications noted were on e nonunion between reimplanted, low heat created autobone and the normal di scal humerus and two metal failures. Each of these techniques for reconstru ctive surgery resulted in a relatively good outcome, although somewhat bett er results were found in the case of prosthetic arthroplasty with low heat created autobone.