Osteosarcoma of the proximal humerus: long-term results with limb-sparing surgery

The purpose of the current study was to analyze the long-term oncologic and functional results and complications associated with limb-sparing surgery and endoprosthetic reconstruction for 23 patients with osteosarcoma of the proximal humerus. There was one Stage IIA lesion, 18 Stage IIB lesions, and four Stage III lesions in this study group. Twenty-two patients were treated with an extraarticular resection that included the deltoid and rotator cuff and one patient was treated with an intraarticular resection that spared the shoulder abductors. In all these patients, the proximal humerus was reconstructed with a cemented endoprosthetic replacement that was stabilized via a technique of static suspension (Dacron tapes) and dynamic suspension (muscle transfers). At latest followup (median, 10 years), 15 patients (65%) were alive without evidence of disease. There were no local recurrences. Prosthetic survival was 100% for the 15 survivors. The Musculoskeletal Tumor Society upper extremity functional score ranged from 24 to 27 (80%-90%). All shoulders were stable and pain-free. Elbow and hand function were preserved in all patients. The most common complication was a transient neurapraxia (n = 8). En bloc extraarticular resection and endoprosthetic reconstruction is a safe and reliable method of limb-sparing surgery for patients with high-grade extracompartmental osteosarcoma of the proximal humerus.