Reconstruction after shoulder resection for tumors: comparison between allograft prosthetic composite and reverse shoulder arthroplasty with cement sleeve

Abstract

Background

Proximal humerus is a common site for primary bone tumors and metastatic disease. Reconstruction with reverse shoulder arthroplasty (RSA) after resection is a surgical challenge and presented a high risk of complication.

Methods

We conducted a retrospective study to identify outcomes of 2 types of reconstruction: allograft prosthetic composite (APC) and RSA with cement sleeve. We analyzed demographic characteristics, clinical outcomes at >2 years, complications, further surgery, and death.

Results

We included 32 patients, at a mean age of 46 years. Fourteen (44%) were metastatic at the time of diagnosis. Eighteen underwent RSA with cement sleeve reconstruction, and 14 underwent APC. Death, complication, reintervention, and revision were analyzed in the 32 patients. The mean humeral resection length was 11 cm. Twelve patients (37.5%) died, at mean 1.8 years after surgery. Neither having an invaded margin (P = .21), having a pathological fracture at the time of the surgical intervention (P = .88), nor being metastatic at the time of diagnosis (P = .07) was associated with an increased risk of death. The complication rate was 50%, the reintervention rate was 16%, and the revision rate was 16%. There was no difference in complication, reintervention, and revision rate between the APC and the cement sleeve group. Twenty-one patients were available for clinical analysis at > 2-year follow-up (mean 46 months). There was no statistical difference in the total Constant score between the cement sleeve group (mean 54 points) and the APC group (mean 59 points), P = .75. There was no difference for AAE at last follow-up between the 2 groups (99.3 points for the cement sleeve group versus 117 points for the APC group, P = .45).

Conclusion

RSA is a suitable option for reconstruction after resection of the proximal humerus. The cement sleeve seems to provide acceptable outcomes without increased risk of complication or further surgery. This option could be considered in metastatic or frail patients.