Bone defects of the distal end of the humerus require complex reconstructions, for which standard prostheses may be insufficient. We investigated the outcomes of distal humeral reconstruction with use of a modular prosthesis.
Fifty-three elbows in fifty-two patients underwent reconstruction with a modular prosthesis (twelve total humeral replacements and forty-one distal humeral replacements) after tumor resection (thirty-eight elbows) or because of massive joint degeneration (fifteen elbows). In the tumor group, twenty-three patients (twenty-four elbows) had metastatic disease and fourteen had a primary tumor. Degenerative defects of the distal end of the humerus were caused by pseudarthrosis (six elbows), prosthetic failure (five), trauma (two), osteomyelitis (one), and supracondylar fracture (one). The mean duration of follow-up for all patients was twenty-eight months (median, thirteen months; range, one to 219 months).
The mean Inglis-Pellicci score in the tumor group was 84 points, and the mean Musculoskeletal Tumor Society score was 78%. Patients with total humeral reconstruction had worse scores than those with distal humeral reconstruction. Twenty-four patients died of disease at a mean of thirteen months after surgery. Local tumor control was achieved in all patients. In the revision group, the mean Inglis-Pellicci score was 76 points. The Inglis-Pellicci score was significantly better for patients in the tumor group. Eight patients (15%) had a deep periprosthetic infection, requiring amputation in one patient (2%) and prosthetic removal in two patients (4%). Four patients (8%) had the implants revised for aseptic loosening.
Modular prostheses of the distal end of the humerus provide a stable reconstruction of the elbow with satisfactory function and disease control in patients with a tumor, but careful patient selection is required when the prostheses are used for revision surgery in patients without a tumor.
[Show abstract][Hide abstract] ABSTRACT: Rarely, the extent of a malignant bone tumour may necessitate resection of the complete humerus to achieve adequate oncological clearance. We present our experience with reconstruction in such cases using a total humeral endoprosthesis (THER) in 20 patients (12 male and eight female) with a mean age of 22 years (6 to 59). We assessed the complications, the oncological and functional outcomes and implant survival. Surgery was performed between June 2001 and October 2009. The diagnosis included osteosarcoma in nine, Ewing's sarcoma in eight and chondrosarcoma in three. One patient was lost to follow-up. The mean follow-up was 41 months (10 to 120) for all patients and 56 months (25 to 120) in survivors. There were five local recurrences (26.3%) and 11 patients were alive at time of last follow-up, with overall survival for all patients being 52% (95% confidence interval (CI) 23.8 to 74) at five years. The mean Musculoskeletal Tumor Society score for the survivors was 22 (73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3) at five years. The use of a THER in the treatment of malignant tumours of bone is oncologically safe; it gives consistent and predictable results with low rates of complication.
The Bone & Joint Journal 09/2012; 94(9):1277-81. DOI:10.1302/0301-620X.94B9.29697 · 3.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 1943, Austin Moore developed the first endoprosthesis fashioned from Vitallium, providing the first alternative to traditional amputation as primary treatment of bone tumors. The success of the Vitallium endoprosthesis has since then led to the development of new materials and designs further advancing limb salvage and reconstructive surgery. Combined with the advent of chemotherapy use and imaging advances, conservative treatment of musculoskeletal tumors has expanded greatly. As the implantable options increased with the development of the Lewis expandable adjustable prosthesis and the noninvasive Phenix Growing prosthesis, receiving the diagnosis of a bone tumor no longer equates to automatic limb loss. Our review details the history and development of endoprostheses throughout orthopedic oncology in the treatment of musculoskeletal tumors.
Journal of Orthopaedics and Traumatology 09/2013; 15(2). DOI:10.1007/s10195-013-0265-8
[Show abstract][Hide abstract] ABSTRACT: Since 1922 surgical approaches toward limb salvage in bone and soft tissue tumours have been documented. There is the famous "Umkippplastik" of Sauerbruch, the "Tikhoff-Linberg" inter-scapulo-thoracic resection or in 1943 a metallic tumour prosthesis for the hip joint in the United States (Moore, Bohlman). Since 1960 acrylic prostheses and metallic prosthesis with bone cement have been in use. Cement-free implants and the first modular ceramic prostheses were implanted in the 1970s in Vienna. At the same time successful chemotherapy in bone sarcomas was introduced by Gerald Rosen and Norman Jaffe. This was mainly the decade of custom-made prostheses. In the 1980s modular tumour prostheses with cone connection to be adopted to the needs of the patient were built intra-operatively. Since 1981 biannual international meetings (ISOLS) have pushed forward the field of bone tumour treatment to allow also tumour resection in wide borders for spine and pelvic tumours. New hope for resistant tumours could be monoclonal antibodies or even dendritic cell therapy.
International Orthopaedics 03/2014; 38(5). DOI:10.1007/s00264-014-2315-0 · 2.11 Impact Factor
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