Retrospective, multicenter, observational study of 112 surgically treated cases of humerus metastasis - 05/08/20

Doi : 10.1016/j.otsr.2020.02.025

Aymeric de Geyer ^a,⁎ , Antoine Bourgoin ^a, Chloé Rousseau ^b, Mickael Ropars ^a, Nicolas Bonnevialle ^c, Charlie Bouthors ^d, Jules Descamps ^e, Lucas Niglis ^f, Fréderic Sailhan ^e, Paul Bonnevialle ^c
the SoFCOT^g
^a Service de chirurgie orthopédique et traumatologique, université de Rennes, CHU de Pontchaillou, 2, rue Henri-Le-Guillou, 35033 Rennes, France
^b Service de santé publique, université de Rennes, CHU de Pontchaillou, 2, rue Henri-Le-Guillou, 35033 Rennes, France
^c Département d’orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac-Toulouse, 31052 Toulouse cedex, France
^d Service de chirurgie orthopédique, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France
^e Service d’orthopédie traumatologie, hôpital Cochin, 27, rue du Faubourg-St-Jacques, 75014 Paris, France
^f Service hospitalo-universitaire d’orthopédie, traumatologie, hôpital Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
^g Sofcot, 56, rue Boissonade, 75014 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

The humerus is the second most common site for metastasis in the peripheral skeleton. These humeral metastases (HM) occur in the midshaft in 42% to 61% of cases and theproximal humerus in 32% to 45% of cases. They are often secondary to primary breast (17–31%), kidney (13–15%) or lung (11–24%) cancer. The optimal surgical treatment between intramedullary (IM) procedures, fixation or arthroplasty is still being debated.

Hypothesis

We hypothesized that fixation and/or arthroplasty are safe and effective options for controlling pain and improving the patients’ function.

Materials and methods

Between 2004 and 2016, 11 French hospitals included 112 continuous cases of HM in 54 men (49%) and 57 women (51%). The average age was 63.7±13.4 years (30–94). The HM occurred in the context of primary breast (30%), lung (23%) or kidney (21%) cancers. The HM was proximal in 35% of cases, midshaft in 59% and distal in 7% of cases. Surgery was required in 69% of patients because of a pathological fracture. The surgical procedure consisted of bundle pinning, plate fixation, arthroplasty or locked IM nailing in 6%, 11%, 14% and 69% of patients, respectively.

Results

Seven patients (6%) had to be reoperated due to surgical site complications including two infections and four fractures (periprosthetic or away from implant). Twelve patients (11%) experienced a general complication. The overall survival was 16.7 months, which was negatively and significantly impacted by the occurrence of a fracture, a diaphyseal location and the type of primary cancer. At the final assessment, 75% had normal or subnormal function and more than 90% were pain-free or had less pain. The final function was not related to the occurrence of a fracture or etiology of the metastasis. In epiphyseal and metaphyseal HM, there was a trend to better function after shoulder arthroplasty than after plate fixation or IM nailing.

Conclusions

Our initial hypothesis was confirmed. Our findings were consistent with those of other published studies. Based on our findings, we recommend using static locked IM nailing with cementoplasty for mid-shaft lesions and modular arthroplasty for destructive epiphyseal or metaphyso–epiphyseal lesions. The criteria for assessing humeral fracture risk should be updated to allow the introduction of a preventative procedure, which contributes to better survival.