A Systematic Review and Meta Analysis of Endprosthetic Replacement versus Cement Spacer in Reconstruction of Proximal Humerus Following Proximal Humerus Metastasis

Abstract Background The choice between cement spacer and endprosthesis in the treatment of metastatic lesions to the proximal humerus is increasingly controversial. However, it may be easier to categorize the patients, their socioeconomic and perioperative parameters into two groups. Aim of the Work This work aims to review the available literature on the topic of endprosthetic replacement versus cement spacer in the reconstruction of the proximal humerus following metastatic lesions to the proximal humerus regarding the surgical technique, its indications, its advantages and limitations. Patients and Methods We followed the PRISMA statement guidelines during this systematic review, and performed all steps according to the Cochrane Handbook of Systematic Reviews of Intervention. Results Four studies were included in this systematic review, a total of 100 patients were included (22 of which had cement spacer and 78 had endprosthesis). Several parameters were compared in the reviewed studies including the MSTS score of the patients; the primary tumor; postoperative complications; the patients’ age; follow-up periods; and the presenting symptoms of the patients. Conclusion The choice of whether to use an endprosthesis or a cement spacer depends on dividing the patients into two groups. Endprosthetic replacement is an appropriate choice for patients with preserved deltoid and axillary nerve function following resection; solitary and non-aggressive metastatic lesion; long- life expectancy with minimal co-morbidities. Cement Spacer is a more appropriate choice in patients with non-functioning deltoid or axillary nerve following resection; multiple and aggressive metastatic lesions; short life expectancy with many co-morbidities, and poor socioeconomic status.