Proximal Humerus Prosthetic Replacement

A proximal humerus prosthetic replacement is a procedure that involves removing a tumor, usually malignant or benign aggressive, of the upper arm bone/humerus and in most instances replacing the bone and shoulder with a special customizable proximal humerus tumor prosthesis. 

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What is Limb Sparing Surgery of the Upper Arm/Shoulder?

This is a procedure that involves removing a tumor of the upper arm bone, called the humerus. In most instances, the bone and shoulder are replaced with a special customizable prosthesis. 

The shoulder girdle consists of the proximal humerus, scapula, and clavicle. Common tumors that affect the upper humerus are various sarcomas, benign aggressive tumors, and metastatic cancers to bone. Some of these tumors include osteosarcomas, chondrosarcomas, and giant cell tumors. Limb-sparing surgery can be performed for approximately 95% of tumors arising from the upper humerus. In some instances the extremity cannot be saved, and an amputation is performed. 

Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, invasion of the chest wall, extensive disease, contamination from a poorly performed biopsy, recurrent disease.

What’s involved in the technique?

What you can expect afterwards

After your surgery you will spend a few nights in the hospital and then will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Patients are usually kept in a sling for 6 weeks to allow the muscles to heal. The elbow is not permitted to extend beyond 45 degrees of flexion for 4 to 6 weeks to allow the biceps muscle to heal which will stabilize the prosthesis. Once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.  

You will be monitored periodically with X-rays over the course of 5 years. Sometimes an MRI and/or CT may be used to additionally monitor the area to make sure the tumor has not come back. You will then have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the bone integrity has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy. 

Types Of Physical Therapy

Proximal Humerus Surgery

Dr. James Wittig narrates a video illustrating the surgical technique for a limb-sparing resection of a chondrosarcoma of the proximal humerus. WATCH VIDEO