Endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus after tumor resection: Cost and benefits.

BACKGROUND: Proximal end of the humerus is a common site for both primary and metastatic bone tumors. Limb salvage with endoprosthetic replacement is the most common means of reconstruction, but it has been proved that cement spacer are more beneficial for inferior shoulder function. Thus, limb salvage can be replaced by cheaper spacers especially in poor societies.

PATIENTS AND METHODS: This study included 20 patients, of whom 14 were female, with a mean age of 40.4 years (range 12-60). Among the study population, six were diagnosed with osteosarcomas, two chondrosarcomas, two myeloma, two lymphoma, four metastatic carcinoma in the breast, two giant cell tumor, and two recurrent chondroplastoma. Limb salvage was successfully done in all patients: Tikhoff-Linberg type I in 12 cases and type V in 8. Endoprosthetic replacement was done in eight cases. An on-table fabricated cement spacer was used in 12 cases.

RESULTS: Follow-up ranged from 12 to 75 months, with a mean of 25.9 months. Functional outcome was almost comparable in both types of reconstruction, especially patient's satisfaction, with a mean function of 65%.

CONCLUSION: A relatively expensive endoprosthesis could be replaced by a much cheaper cement spacer if their function is comparable.