Complication and revision risks of surgical treatment for proximal humerus metastases: a systematic review.

Abstract

Surgical treatments for proximal humerus metastasis include modular prosthesis, intramedullary nailing, plate fixation, and hemiarthroplasty. However, it is controversial which surgical treatment could offer less complications and implant failure. The purpose of our study was to report the risk of complications, reoperations and revisions in patients with proximal humerus metastasis treated with modular prosthesis, intramedullary nailing, plate fixation, or hemiarthroplasty. We performed research in the PubMed and Scopus libraries, obtaining 2247 studies. We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients with proximal humerus metastasis treated with intramedullary nailing, plate fixation, hemiarthroplasty, or megaprosthesis. We included 11 studies (357 patients) reporting patients treated with modular prosthesis (n = 181), intramedullary nailing (n = 101), plate fixation (n = 51) and hemiarthroplasty (n = 24). The risk of complications in patients with proximal humerus metastasis treated with modular prosthesis was 0-40%, with intramedullary nailing was 0-39%, with plate fixation was 0-67% and with hemiarthroplasty was 8%. The risk of reoperation in patients treated with modular prosthesis was between 0 and 20%, with intramedullary nailing was 0-3%, and with plate fixation was 0-33% and no patient treated with hemiarthroplasty had a reoperation. The risk of removal of the implant in patients treated with modular prosthesis and plate fixation was 0-20% and 0-33%, respectively. No patients treated with intramedullary nailing and hemiarthroplasty had a removal of the implant. Modular prosthesis, intramedullary nailing, plate fixation and hemiarthroplasty seem to have similar risk of complications, reoperation and removal of the implant. Surgeons should consider the indications of each treatment option, taking into account other factors such as the location and size of the lesion, the quality of the cortical bone and the patient's life expectancy.