Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment?

Abstract

Normal function of the upper limb is seldom restored after limb-sparing surgery for tumors of the proximal humerus. The literature suggests superior shoulder function is achieved in the short term with reverse total shoulder arthroplasty compared to other techniques when performed for conditions with rotator cuff deficiency. It is unclear whether this superiority is maintained when reverse total shoulder arthroplasty is performed for tumors. When performed for tumors, we determined whether reverse total shoulder arthroplasty restores function and improves motion, the complications associated with the surgery, and whether reverse total shoulder arthroplasty with autologous grafting is associated with bone resorption. We retrospectively reviewed 14 patients who had undergone reverse total shoulder arthroplasty for tumors of the proximal humerus. Four patients died, leaving nine patients for review. The surviving patients were evaluated clinically and radiographically. The minimum followup was 0.6 years (mean, 7.7 years; range, 0.6-12 years). At last followup, mean active abduction was 157° and mean functional Constant-Murley score was 76%. One patient had a deep infection and one developed a loose prosthesis; both were treated with single-stage exchange. At last followup, both patients had reasonable function without evidence of infection or loosening. Radiographic graft resorption was seen in all but one patient. Our observations suggest, at medium-term followup, reverse total shoulder arthroplasty is a reasonable option for tumors of the proximal humerus. It has low morbidity, restores a mean active abduction of 157°, and limits the impairment of activities of daily living. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.