Allograft-prosthetic composite versus megaprosthesis for proximal humerus reconstruction after tumor resection: a meta-analysis of clinical outcomes.

Background: Allograft prosthetic composite (APC) and megaprosthesis (MP) have both been used to reconstruct the proximal humerus after its resection due to primary or secondary tumors. However, varied results have been reported in the literature with no consensus on which reconstruction has better overall outcomes.

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through September 2024. The compared outcomes consisted of adverse events, patient-reported outcomes measures, and range of motion. Ten studies and 400 patients were included, with 115 in the APC group and 285 in the MP group.

Results: The APC group had a higher rate of reoperations (odds ratio, 2.50; 95% CI, 1.40-4.45; P=0.002) than did the MP group over an average follow-up of 7.0 years. However, better postoperative flexion (mean difference, 10.11; 95% CI, 5.33-14.90; P<0.001) and Musculoskeletal Tumor Society scores (mean difference, 3.73; 95% CI, 1.37- 6.08; P=0.002) were seen in the APC group.

Conclusions: The present study shows a lower rate of revision with the use of MP but better functional outcomes and forward flexion with APC as the surgical option for proximal humerus reconstruction. Level of evidence: III.