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Page 2 of 14 Pinnamaneni et al. J Cancer Metastasis Treat 2021;7:7 I http://dx.doi.org/10.20517/2394-4722.2020.94

Table 1. Malawer surgical classification system of limb-sparing resections of the shoulder girdle
Type I Intra-articular proximal humeral resection
Type II Partial scapulectomy
Type III Intra-articular total scapulectomy
Type IV Extra-articular scapular and humeral head resection
Type V Extra-articular humeral and glenoid resection
Type VI Extra-articular humeral and total scapular resection

Table 2. Musculoskeletal tumor society functional evaluation (upper limb)

Score Pain Function Emotional Hand positioning Manual dexterity Lifting ability
acceptance
5 No pain No restriction Enthused Unlimited No limitations Normal load
4 (Intermediate) (Intermediate) (Intermediate) (Intermediate) (Intermediate) (Intermediate)
3 Modest/non-disabling Recreational Satisfied Not above shoulder Loss of fine Limited (minor load)
restriction movements
2 (Intermediate) (Intermediate) (Intermediate) (Intermediate) (Intermediate) (Intermediate)
1 Moderate/ Partial occupational Accepts Not above waist Cannot pinch Helping only(cannot
intermittently disabling restriction overcome gravity)
0 Severe/continuously Total occupational Dislikes None Cannot grasp Cannot move
disabling restriction

[5]
Table 3. Henderson et al. classification of complications
Type of failure Definition
1 Soft tissue failure
2 Aseptic loosening
3 Structural failure
4 Infection
5 Tumor progression

stability are challenging. Resection for primary bone tumors may require complete or partial resection
of the deltoid, rotator cuff, joint capsule, axillary nerve, and portions of the scapula to achieve oncologic
margins. Reconstruction after the latter resection creates even more complex reconstructive issues.
The purpose of our article is to provide a comprehensive review of current reconstruction options after
proximal humeral resection for oncologic reasons. This review is supplemented with case-based examples.

CLASSIFICATION AND OUTCOME ASSESSMENT
Classification of shoulder girdle resections according to Malawer range from types I to VI . This
[3]
classification is based on surgical margins, relationship of the tumor to other anatomic compartments,
status of the glenohumeral joint, magnitude of the surgical procedures, and status of the abductor
mechanism (deltoid/rotator cuff) [Table 1]. Functional and quality of life outcomes after treatment of
musculoskeletal tumors are most commonly assessed with the Musculoskeletal Tumor Society (MSTS)
[4]
score . This scale is based on questions about functional outcomes, pain, and emotional status [Table 2].
While it has been shown to be a reliable tool for the upper extremity, the MSTS score can overestimate
[4]
function as compared to the patient-perceived score . As for other sites, complications following these
procedures are classified as described by Henderson et al. [Table 3].
[5]

PREOPERATIVE CONSIDERATIONS
In general, the orthopedic oncology patient has several specific characteristics that affect the choice
of surgical reconstruction. The potential for a shortened survival, particularly in patients with diffuse
metastatic disease, myeloma, and some primary bone tumors, should be considered. Orthopedic oncology
patients often need a surgical solution that allows for immediate stability to allow restoration of function,