Original article
Treatment of proximal humeral chondrosarcoma with resection and allograft

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Chondrosarcoma of the proximal humerus is an uncommon malignant bone tumor, and limited information is available about treatment. We retrospectively reviewed 31 patients treated by resection and replacement with allograft implants during the past 24 years. The patients were followed up for an average of more than 16 years. Despite some allograft complications, the overall success rate for the grafts was 77%, and patient survival was 96%. Only 1 patient died. Two patients required amputation for local recurrences, and the remainder did reasonably well despite some functional problems. On the basis of this study and by comparison data, we believe that proximal humeral chondrosarcomas are less malignant than chondrosarcomas in other sites. In comparing them against 26 metallic implants, we believe that resection and allograft implantation remains a generally successful treatment, although the improvement of the metallic devices over the years has made this technique more available and acceptable.

Section snippets

Materials and methods

In an article published in 1990, we reported on 20 patients with tumors of the humerus treated by resection and allograft replacement, 9 of whom had had chondrosarcomas.11 In the present series of patients treated since 1972 and listed in our database, we found 499 patients who had had a chondrosarcoma.19 In only 64 of these patients were tumors located in the proximal humerus. Proximal humeral resection and implant of a cadaveric allograft was done in 31 patients, 26 were treated with massive

Results

As can be noted by study of Table II, there were no significant differences for the complications for patients with allografts and those with metallic devices. The metallic devices had a shorter duration of follow-up because modular and special devices were not available in the early years of our treatment.

Table III shows that the success of the allograft transplantation over the mean period of 15 years was 77%, which was similar to that in the femur and tibia and better (P < .03) than for the

Discussion

Chondrosarcoma of the proximal humerus is uncommon. Only 64 of 499 of our patients with chondrosarcomas had tumors at that site. Thirty-one of the chondrosarcomas were resected and replaced with a cadaveric allograft and 26 with metallic implants. The results for the 2 series of implants were virtually identical, although the follow-up period was shorter for the metal components. The survival data for the entire series of 57 patients were remarkably good, with only 3 deaths. The survival rate

Conclusion

Although resection and allograft replacement is by no means a perfect solution for patients with proximal humeral chondrosarcoma, the end results for patient survival, allograft retention, and maintenance of structure are reasonably good, and the system remains as a useful approach.

References (36)

  • M. Kassab et al.

    Twenty-nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7 year follow-up

    Rev Chir Orhop Reparatrice Appar Mot

    (2005)
  • H.C. Bauer et al.

    Low risk of recurrence of enchondroma and low grade chondrosarcoma in extremities80 patients followed for 2-25 years

    Acta Orthop Scand

    (1995)
  • W.H. Berrey et al.

    Fractures of allograftsFrequency, treatment and end results

    J Bone Joint Surg Am

    (1990)
  • G. Bos et al.

    Prosthetic replacement of the proximal humerus

    Clin Orthop

    (1987)
  • H.J. Burrows et al.

    Excision of tumours of humerus and femur with restoration by internal prostheses

    J Bone Joint Surg Br

    (1975)
  • M. Campanacci

    Bone and soft tissue tumors

  • A.T. Croci et al.

    The use of a modular titanium endoprosthesis in skeletal reconstructions after bone tumor resections: method presentation and analysis of 37 cases

    Rev Hosp Clin Fac Med Sao Paulo

    (2000)
  • L.F. De Wilde et al.

    Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery

    Clin Orthop

    (2005)
  • H.D. Dorfman et al.

    Bone tumors

  • W.F. Enneking

    A system of staging musculoskeletal neoplasms

    Clin Orthop

    (1986)
  • A.I. Eriksson et al.

    The management of chondrosarcoma of bone

    Clin Orthop

    (1980)
  • M.C. Gebhardt et al.

    Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor

    J Bone Joint Surg Am

    (1990)
  • P.I. Getty et al.

    Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal humerus

    J Bone Joint Surg Am

    (1999)
  • S. Gitelis et al.

    Chondrosarcoma of boneThe experience at the Istituto Ortopedico Rizzoli

    J Bone Joint Surg Am

    (1981)
  • J.H. Healey et al.

    Chondrosarcoma

    Clin Orthop

    (1986)
  • F.J. Hornicek et al.

    Factors affecting non union of the allograft-host junction

    Clin Orthop

    (2001)
  • F.Y. Lee et al.

    Chondrosarcoma of bone: an assessment of outcome

    J Bone Joint Surg Am

    (1999)
  • C.G. Lord et al.

    The incidence, nature and treatment of allograft infections

    J Bone Joint Surg Am

    (1988)
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