Our Positive and Negative Deductions regarding the Results of Tumor Prostheses after Resection of Primary and Metastatic Tumors of the Proximal Humerus

INTRODUCTION: The aim of modular tumor prostheses for primary and metastatic tumors of the proximal humerus is to provide the maximum possible physical, psychological and social activity despite the wide resection areas. The present study aims to show the suitability of modular tumor prostheses of the shoulder joint in the early period without considering the postoperative life expectancy in patients diagnosed with a malignant tumor of the proximal humerus.
METHODS: In this study, a total of 53 patients were evaluated retrospectively. Our patients consisted of 32 female and 21 male patients who were diagnosed and underwent surgery at our Orthopedics and Traumatology clinics between 1980 and 2003. The 14 patients we had personally followed-up at our clinic were included in Group A, while the 39 patients who were evaluated using the data in the archives were included in Group B. The mean age of the patients was 57 years in Group A and 39 years in group B. Modular tumor prostheses were mostly used for the 53 patients in total in Group A and B, but a few patients received a tumor prosthesis made of Polyacetalharz or an isoelastic tumor prosthesis.
RESULTS: There was no sign of postoperative metastasis or local residual tumor in any of the 14 patients in Group A. Seven patients had no pain and five patients had only mild pain. None of the patients required opioids. Postoperative cranial subluxation was seen in ten patients after a mean duration of 34.5 months. Resurgery was performed only in four of 14 patients in group A. Multiple bones, or visceral/pulmonary metastases were found at the same time as the initial diagnosis in Group B patients, and these subjects died within a mean postoperative duration of six months. Nine of the 39 patients underwent resurgery. There were six patients with no pain in Group B. There was no recorded data related to pain in 25 patients. The movement limitation was significant in 13 patients and mild in two patients.
DISCUSSION AND CONCLUSION: The findings suggest that it was possible to achieve a good level of movement capacity and muscle strength although limited due to the refixation of the muscles and tendons protected during the wide intraoperative resections with modular tumor resection prosthesis implantation, despite some tolerable pain in the early period, when the results were compared with other treatment options, such as arthrodesis or amputation. It is encouraging that the elbow, forearm and hand functions were fully protected in all patients and good quality of life was ensured considering the cosmetic results, patient psychology and daily social activities.