J Shoulder Elbow Surg. 2023 Oct 14:S1058-2746(23)00734-6. doi: 10.1016/j.jse.2023.09.009. Online ahead of print.
BACKGROUND: Giant cell tumors of bone (GCTB) are rare aggressive tumors and proximal humerus is a relatively rare location for GCTB as well, limited evidence exists on which surgical approaches and reconstruction techniques are optimal. Here, using the largest case series to date, we evaluated the recurrence rate of proximal humerus GCTBs and the functional outcomes of different resection and reconstruction options in this multicenter study.
METHODS: All 51 patients received initial surgical treatment for proximal humerus GCTBs from January 2007 to December 2020, with a minimum two-year follow-up. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were patient-reported and assessed by the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder and Hand (QuickDASH) instrument.
RESULTS: Mean follow-up was 81.5 months (range, 30-191 months), and overall recurrence rate was 17.6% (9/51). The majority of the recurrence (N=7) occurred in the first two years of follow-up. The intralesional curettage group (N=23) had a statistically significant difference in recurrence rate compared to en-bloc resection (N=28) (34.8% vs. 3.6%, p=0.007). Among patients receiving en-bloc resection, 16 shoulders were reconstructed with hemiarthroplasty, 8 with reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction, and 4 with arthrodesis. Based on intention-to-treat analysis, the mean functional MSTS scores of the curettage groups, rTSA with APC, hemiarthroplasty, or arthrodesis was 26.0±3.1 vs. 26.0±1.7 vs. 20.3±2.8 vs. 22.5±1.3 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.004]), respectively, while for QuickDASH, it was 14.0±11.0 vs. 11.6±4.5 vs. 33.1±11.8 vs. 21.6±4.7 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.003]), respectively.
CONCLUSIONS: Based on our data, en-bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate, and no significant difference in functional outcome scores for proximal humerus GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for initial treatment of proximal humerus GCTBs.