[Prosthesis replacement of proximal humerus after resection of malignant tumor]

To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor.

From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging, I A) and 2 patients with giant cell tumor of the bone (II A, II B). By the International Society of Limb Salvage (ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients' psychological conditions as well as their limb pain, shape, locality, activity, and function were also observed.

The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except one patient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22 degrees to 41 degrees (mean, 25 degrees), bending angle from 29 degrees to 80 degrees (mean, 35 degrees), abduction angle from 5 degrees to 28 degrees, and circumgyrate angle from 15 degrees to 22 degrees in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patients with osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points.

The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.