Hemiarthroplasty for Elderly With Proximal Humeral Mets (PHM-HA)

The Application of Hemiarthroplasty in Elderly Patients With Proximal Humeral Metastases

Bone metastases are common in patients with advanced cancer and frequently involve the proximal humerus, leading to severe pain and loss of shoulder function. Shoulder arthroplasty is an important surgical option for restoring limb function and relieving pain in these patients. However, elderly patients often have multiple comorbidities, and it remains unclear whether age affects surgical outcomes and prognosis after arthroplasty for proximal humeral metastases.

This retrospective observational study reviewed patients with isolated proximal humeral metastases who underwent shoulder arthroplasty at our institution. Patients were divided into elderly and younger groups based on age, and clinical outcomes were compared between the groups. Evaluated outcomes included operative characteristics, postoperative pain, limb function, complications, survival, recurrence, and quality of life.

The aim of this study is to determine whether age influences prognosis and functional recovery after shoulder arthroplasty for proximal humeral metastases, and to assess the feasibility and effectiveness of this surgical procedure in elderly patients.

Study Overview

• Status: Completed
• Conditions: Metastatic Bone Tumor; Bone Metastases of a Malignant Tumor
• Intervention / Treatment: Procedure: Proximal Humeral Hemiarthroplasty

Detailed Description

This retrospective observational study reviewed patients who underwent proximal humeral hemiarthroplasty (PHH) for solitary metastatic lesions of the proximal humerus at our institution between 2013 and 2021. A total of 53 patients with histopathologically confirmed metastatic bone tumors were included in the analysis. The study population consisted of 25 males and 28 females, with ages ranging from 43 to 82 years.

Patients were divided into two groups according to age: Group A (≥65 years, n = 25) and Group B (<65 years, n = 28). All metastatic lesions were unilateral and located in the proximal one-third of the humerus without involvement of the scapula.

The most common primary malignancies included breast cancer, lung cancer, renal cell carcinoma, thyroid cancer, prostate cancer, colorectal cancer, hepatocellular carcinoma, gastric cancer, uterine cancer, and cancer of unknown primary origin. Prior resection of the primary tumor had been performed in 22 patients before presentation. Nineteen patients had comorbidities such as diabetes mellitus, hypertension, chronic gastritis, or pulmonary emphysema. Pathological fractures were present in 19 cases.

All patients underwent wide tumor excision followed by proximal humeral hemiarthroplasty using a Malawer type I resection technique. Clinical and surgical data were collected from medical records for subsequent analysis.

• Study Type: Observational
• Enrollment (Actual): 53

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

This study included adult patients with solitary proximal humeral metastases who underwent proximal humeral hemiarthroplasty at our institution between 2013 and 2021. Both male and female patients were eligible. Patients were divided into two groups based on age (≥65 years and <65 years) to compare surgical outcomes, functional recovery, complications, and survival. All patients had confirmed metastatic bone tumors, with lesions localized to the proximal humerus and without involvement of the scapula or axillary nerve. Patients with multiple bone metastases or severe comorbidities were excluded.

Description

Inclusion Criteria:

• Patients with a single metastatic lesion in the proximal humerus, confirmed by imaging or biopsy.

Presence of pathological fracture or a severe osteolytic lesion at risk of fracture (Mirels score ≥9).

Poor response to radiotherapy according to RECIST 1.1 criteria.

Persistent severe shoulder pain or significant loss of shoulder function.

Estimated life expectancy >3 months at the time of surgery..

Exclusion Criteria:

• Patients with multiple bone metastases involving two or more skeletal sites.

Metastatic lesions affecting the scapula, axillary nerve, or brachial plexus.

Death during the perioperative period.

Presence of three or more significant comorbidities, such as uncontrolled diabetes, severe cardiopulmonary disease, or chronic renal failure.

Loss to follow-up within 3 months after surgery.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Elderly Patients (≥65 Years); Patients aged 65 years or older with solitary proximal humeral metastases who underwent proximal humeral hemiarthroplasty at our institution.	Procedure: Proximal Humeral Hemiarthroplasty; Patients underwent wide tumor excision followed by proximal humeral hemiarthroplasty. En bloc resection was performed according to tumor-free principles, with preservation of the axillary nerve and deltoid muscle whenever possible. Osteotomy was performed 2-3 cm distal to the tumor margin. A tumor-specific prosthesis was implanted and soft tissues were reconstructed. A Ligament Advanced Reinforcement System (LARS) was used when necessary to improve joint stability.
Younger Patients (<65 Years); Patients younger than 65 years with solitary proximal humeral metastases who underwent proximal humeral hemiarthroplasty at our institution.	Procedure: Proximal Humeral Hemiarthroplasty; Patients underwent wide tumor excision followed by proximal humeral hemiarthroplasty. En bloc resection was performed according to tumor-free principles, with preservation of the axillary nerve and deltoid muscle whenever possible. Osteotomy was performed 2-3 cm distal to the tumor margin. A tumor-specific prosthesis was implanted and soft tissues were reconstructed. A Ligament Advanced Reinforcement System (LARS) was used when necessary to improve joint stability.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
(ASES) Score	Shoulder Function Assessed by the American Shoulder and Elbow Surgeons (ASES) Score	Postoperative follow-up (up to 24 months)

Collaborators and Investigators

• Sponsor: Sichuan Provincial People's Hospital
• Investigators: Study Chair: Ji Zhou, Sichuan Provincial People's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2013
• Primary Completion (Actual): December 31, 2021
• Study Completion (Actual): September 4, 2025

Study Registration Dates

• First Submitted: March 10, 2026
• First Submitted That Met QC Criteria: March 10, 2026
• First Posted (Actual): March 13, 2026

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: March 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Hemiarthroplasty; Shoulder Arthroplasty; Elderly Patients; Bone Metastases; Proximal Humeral Metastases
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Neoplasms by Site; Neoplasms; Bone Neoplasms
• Other Study ID Numbers: 2025-522

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to patient privacy concerns and ethical restrictions. The data include sensitive medical information collected from hospital records, and sharing such data could risk identification of patients.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No