Long-term Outcomes of Biological Reconstruction for Primary Bone Sarcoma of the Humerus

Options for the reconstruction of bone defects following resection of primary bone sarcomas of the humerus include massive endoprostheses or biological reconstruction. We report the oncological, clinical, and functional outcomes in patients treated with biological reconstructions.

This study included 23 consecutive patients with primary bone sarcoma of humerus who underwent en-bloc resection and biological reconstructions at a single institution. Four groups of patients were identified. Group A: twelve patients with vascularized fibula epiphyseal transfer. Group B: four patients with structural grafts with vascularized fibula. Group C: four patients with structural grafts with non-vascularized fibula. Group D: three patients with only structural grafts (allograft or reimplanted bone only). The postoperative oncological outcomes, complications, reoperation rates, and postoperative limb function using the Musculoskeletal Tumor Society (MSTS) scores were evaluated.

The median age at diagnosis was 8 years (range=3-54 years). The median follow-up was 87 months (range=6-172 months). Graft complications at recipient sites occurred in 13 patients including fracture in seven, non-union in four, and avascular necrosis in two. Donor site peroneal nerve palsy occurred in seven patients. Local recurrence and metastases occurred in one and two patients, respectively. At the last follow-up, twenty‑two patients were alive (21 continuously disease-free for a median of 87 months, and one with no evidence of disease), and one patient died of disease. The mean MSTS scores for all patients was 78.9%, and this was similar in the four groups: 77.5%, 72.5%, 85.8%, and 83.3% in Groups A, B, C, and D, respectively.

Biological reconstruction of the humerus is a complex procedure with a risk of complications but has good oncological and functional outcomes.