Endoprosthesis vs. nail-cement spacer application for reconstruction after oncologic proximal humeral resection: is there a difference in functional outcome?

Sandeep Sehrawat; Abhijit Behera; Love Kapoor; Venkatesan Sampath Kumar; Sameer Bakhshi; Shah Alam Khan

doi:10.1016/j.jseint.2024.01.018

Endoprosthesis vs. nail-cement spacer application for reconstruction after oncologic proximal humeral resection: is there a difference in functional outcome?

JSES Int. 2024 Feb 24;8(4):692-698. doi: 10.1016/j.jseint.2024.01.018. eCollection 2024 Jul.

Authors

Sandeep Sehrawat¹, Abhijit Behera¹, Love Kapoor¹, Venkatesan Sampath Kumar¹, Sameer Bakhshi², Shah Alam Khan¹

Affiliations

¹ Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.
² Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: The proximal humerus is a common site for primary malignant and benign aggressive bone tumors, necessitating wide resection and subsequent skeletal defect reconstruction. Various reconstruction options include osteoarticular allografts, autografts, endoprosthesis, nail-cement spacer, reverse shoulder arthroplasty, and allograft-prosthesis composites. However, there is no consensus on the optimal reconstruction method. This study aims to compare functional outcomes and complications between these two methods.

Methods: A total of 40 patients with proximal humerus tumors who underwent endoprosthesis or nail-cement spacer reconstruction between March 2012 and December 2020 were included. The mean follow-up in the study was 31.37 +/- 12 months. Demographic and clinical data were collected, and functional outcomes were assessed using the Musculoskeletal Tumor Society 93 scoring system and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Complications and oncological outcomes were recorded.

Results: Both groups were similar in terms of demographic and clinical variables. Endoprosthesis reconstruction demonstrated significantly better active shoulder forward flexion compared to nail-cement spacer (45.8 vs. 25.2 degrees) (P = .015). Endoprosthesis group also exhibited greater active shoulder internal rotation (68.25 vs. 63.25 degrees) (P = .004). No statistically significant differences were observed in overall functional outcomes. Complications, including radial nerve palsy and infection, were comparable between groups, with one case of spacer loosening.

Conclusion: Both endoprosthesis and nail-cement spacer reconstruction provide comparable functional outcomes and complication rates following proximal humerus tumor resection. Nail-cement spacer offers a cost-effective alternative for patients in resource-constrained settings.

Keywords: Endoprosthesis reconstruction; Functional outcomes; Limb salvage surgery; Nail-cement spacer reconstruction; Oncologic resections; Proximal humerus tumors.