Introduction
Functional reconstruction of the shoulder joint following excision of a malignant proximal humeral tumour is a difficult proposition.
Method
Eleven patients with primary osteosarcoma or Ewing’s sarcoma underwent reconstruction with a composite of extra-corporeally
irradiated autograft with the addition of a long stemmed hemiarthroplasty. At a mean follow-up of 5.8 years two patients had
died from disseminated disease and one patient had undergone amputation for local recurrence. The eight patients with a surviving
limb were examined clinically and radiographically.
Result
The mean Toronto Extremity Salvage Score was 74 and Musculo-Skeletal Tumour Society score 66. Rotation was well preserved
but abduction (mean 32°) and flexion (40°) were poor. There was a high rate of secondary surgery, with five out of eleven
patients requiring re-operation for complications of reconstruction surgery. Radiographic estimate of graft remaining at follow
up was 71%. There were no infections, revisions or radiographic failures.
Conclusion
Whilst the reconstructions were durable in the medium term, the functional outcome was no better than with other reported
reconstructive methods. The composite technique was especially useful in subtotal humeral resections, allowing preservation
of the elbow joint even with very distal osteotomy. Bone stock is restored, which may be useful for future revision surgery
in this young group of patients.
Keywords Bone sarcoma - Humerus - Extracorporeal irradiation - Endoprosthesis