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Page 6 of 14 Pinnamaneni et al. J Cancer Metastasis Treat 2021;7:7 I http://dx.doi.org/10.20517/2394-4722.2020.94

A B

Figure 5. Anteroposterior radiographs of a 57-year-old male with: chondrosarcoma of the proximal humerus preoperatively (A); three
years after wide excision and proximal humeral APC reconstruction (B). Blue arrow notes the junction between the allograft and native
bone.

resection [Figures 5-7]. As for osteosarcoma, the typical metaphyseal location lends itself to intra-articular
resection.

Benign locally aggressive tumors
Aggressive benign tumors with extensive bone destruction may necessitate resection if in the proximal
humerus. While these indications are rare, giant cell tumor of the bone is the most likely benign tumor to
require resection [Figure 8]. Rarely, aneurysmal bone cyst, osteoblastoma, and chondromyxoid fibroma
require resection. Aneurysmal bone cyst is unlikely to require resection and reconstruction in pediatric
patients, but they are particularly aggressive, secondary, or recurrent in an adult patient. Osteoblastoma is
rare in the proximal humerus and necessitates resection only when it behaves aggressively, such as when
it is hard to differentiate from osteosarcoma. Chondromyxoid fibroma is also an uncommon proximal
humeral tumor but has the potential to behave aggressively.

OPERATIVE OPTIONS
Osteoarticular allograft
Reconstruction of the proximal humerus using an osteoarticular allograft [Figure 9] is a completely biologic
articular reconstruction option.

Indications: Osteoarticular allograft reconstruction can be considered in pediatric and young patients due
[9]
to concerns with prosthesis-related complications . Contraindications include evidence of intra-articular
tumor, inadequate host tissue to reconstruct the glenohumeral joint, and pre-existing glenohumeral
arthrosis. A relative contraindication is need for radiotherapy, which may lead to non-union at the graft-
host interface.

Technique: Although tissue matching is not required, size matching is important. The planned resection
of the humerus should be measured on advanced imaging. This is important to ensure appropriate length