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Gonzalez MR, Okay E, Sodhi AS, Lozano-Calderon SA. Reconstruction of the elbow with distal humerus endoprosthetic replacement after tumor resection: a systematic review of the literature and institutional case series. J Shoulder Elbow Surg 2024; 33:1104-1115. [PMID: 38360351 DOI: 10.1016/j.jse.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/07/2023] [Accepted: 12/25/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Distal humerus replacement (DHR) is a modular endoprosthesis mainly used for bone reconstruction after resection of primary or metastatic bone lesions. Studies on DHR failure rates and postoperative functional outcomes are scarce. We sought to assess implant survival, modes of failure, and functional outcomes in patients undergoing DHR for oncologic indications. METHODS A systematic review of the PubMed and Embase databases was performed. PRISMA guidelines were followed for this manuscript. Our study was registered on PROSPERO (457,260). Quality appraisal of included studies was conducted using the STROBE checklist. Prosthetic failure was assessed using the Henderson classification for megaprosthetic failures. We additionally performed a retrospective review of patients treated with a DHR for oncologic indications at a large tertiary care academic center. Weighted means were calculated to pool data. RESULTS Eleven studies with a total of 162 patients met the inclusion criteria. Mean follow-up was 3.7 years (range, 1.66-8 years). Henderson type 2 failures (aseptic loosening) were the most common mode of failure, occurring in 12% of cases (range, 0%-33%). Five-year implant survival was 72% (range, 49%-93.7%). Mean postoperative Musculoskeletal Tumor Society (MSTS) score was 81.1 (range, 74-84.3). In our institutional case series, 2 out of 5 patients had DHR revision for periprosthetic fracture and aseptic loosening at 16 and 27 months after surgery, respectively. CONCLUSIONS Distal humerus replacement is a successful reconstruction strategy for tumors of the distal humerus, with high implant survival and good to excellent functional outcomes.
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Affiliation(s)
- Marcos R Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erhan Okay
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alisha S Sodhi
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderon
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Beltrami G, Rajan S, Nucci AM, Galeotti A, Guido D, Campanacci D, Innocenti M. Biological Prosthesis (Hollow 3D-Printed Titanium Custom-Made Prosthesis and Bone Graft) for Humeral Reconstruction in Pediatric Oncologic Patients: Surgical Indications and Results. Bioengineering (Basel) 2023; 10:1371. [PMID: 38135962 PMCID: PMC10741201 DOI: 10.3390/bioengineering10121371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
This study presents the mid-term outcomes of a novel "biological prosthesis" for pediatric humerus reconstruction after major bone tumor removal. This approach involves a hollow 3D-printed titanium custom-made prosthesis combined with bone grafting. The primary aim was to preserve and revitalize the unaffected autologous proximal or distal humeral stump. Between 2017 and 2021, we treated five pediatric patients (mean age 11.2 years; range 7-17) with humeral bone sarcomas. A one-stage surgical procedure involved tumor resection and implanting a hollow 3D-printed custom-made prosthesis. In two cases, we preserved the proximal humerus; in two, the distal part; and in one, both. Graft materials included homologous bone chips in three cases and free vascularized fibular grafts in two cases. All patients were clinically and radiographically assessed after a mean follow-up of 32.2 months (range of 14-68). No significant complications were observed, and no implant revisions were needed. Osseointegration was evident in all cases within eight months post-surgery; vascular support for the remaining autologous stump was demonstrated in all cases. Our hollow 3D-printed custom-made prosthesis and bone grafting offer the potential for partial or complete articular surface preservation. This approach encourages revascularization of the epiphysis, leading to satisfactory outcomes in humerus reconstruction within the pediatric population.
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Affiliation(s)
- Giovanni Beltrami
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Sreeraj Rajan
- Department of Orthopaedic Oncology, Aster MIMS, Calicut 673016, India
| | - Anna Maria Nucci
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Alberto Galeotti
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Davide Guido
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Domenico Campanacci
- Department of Orthopedic Oncology and Reconstructive Microsurgery, CTO, 10100 Florence, Italy
| | - Marco Innocenti
- Orthoplastic Surgery Division, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Campanacci DA, Scanferla R, Innocenti M, Muratori F, Puccini S, Scoccianti G, Beltrami G, Capanna R, Innocenti M. Are Vascularized Fibula Autografts a Long-lasting Reconstruction After Intercalary Resection of the Humerus for Primary Bone Tumors? Clin Orthop Relat Res 2023; 481:2185-2197. [PMID: 37364172 PMCID: PMC10566995 DOI: 10.1097/corr.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A vascularized fibula graft (VFG) is the vascular autograft most frequently used to restore large segmental long bone defects, particularly in the upper limb. Because the use of a vascularized fibula involves an operation in an uninvolved extremity with potential morbidity, it is important to document that this type of reconstruction is successful in restoring function to the humerus. However, the long-term results of VFG after intercalary resection of the humeral diaphysis for bone tumors are still unknown. QUESTIONS/PURPOSES (1) What was the complication rate of reconstruction? (2) What was the functional result after surgical treatment, as assessed by the Musculoskeletal Tumor Society (MSTS) score, the American Shoulder and Elbow Society (ASES) score, and Constant score? (3) What was the survivorship of these grafts free from revision and graft removal at 5, 10, and 15 years? METHODS Between 1987 and 2021, 127 patients were treated at our institution with en bloc resection for a primary malignant or an aggressive benign bone tumor of the humerus; we excluded patients treated with extra-articular resection or amputation. Of those, 14% (18 of 127) were treated with intercalary resection of the humeral diaphysis for primary bone tumors and reconstruction with VFG, with or without a bulk allograft, and were analyzed in this retrospective study. Generally, our indications for reconstruction with VFG are intercalary resection of the humerus for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands, in whom adequate bone stock of the proximal and distal epiphysis can be preserved. In 13 patients, VFG was used alone, whereas in five patients, a massive allograft was used. Our policy was to use VFG combined with a massive allograft in patients undergoing juxta-articular joint-sparing resections in which proximal osteotomy was performed close to the anatomic neck of the humerus to obtain more stable fixation and better tendinous reattachment of the rotator cuff and deltoid. All 18 patients who were treated with a VFG were available for follow-up at a minimum of 2 years (median follow-up 176 months, range 26 to 275 months), and although three have not been seen in the past 5 years and are not known to have died, they had 172, 163, and 236 months of follow-up, and were included. The median age at surgery was 25 years (range 2 to 63 years), the median humeral resection length was 15 cm (range 8 to 21 cm), and the median fibular length was 16 cm (range 12 to 23 cm). Complications and functional scores were ascertained by chart review that was performed by an individual not involved in patient care. Functional results were assessed with the MSTS score (range 0 to 30), the ASES score (range 0 to 100), and the Constant score (range 0% to 100%). Survivorship was estimated using a Kaplan-Meier survivorship estimator, which was suitable because there were few deaths in this series. RESULTS Seven patients underwent a revision procedure (one radial nerve transient palsy because of screw impingement, four nonunions in three patients with one humeral head avascular necrosis, treatment for screw-related pain in one patient, and two VFG fractures), and one patient underwent VFG removal. Donor site complications were observed in four patients (one ankle valgus deformity and three claw toes-the first toe in two patients and the other toes in the third). At the final clinical control, at a median follow-up of 176 months (range 26 to 275 months), the median MSTS score was 30 of 30 (range 28 to 30), the median ASES score was 98.3 (range 93 to 100), and the median Constant score was 93.5% (range 79% to 100%). Revision-free survival was 71% (95% CI 53% to 96%) at 5 years and 57% (95% CI 37% to 88%) at 10 and 15 years; VFG removal-free survival was 94% (95% CI 83% to 100%) at 5, 10, and 15 years. CONCLUSION VFG appears to be an effective reconstructive option after humeral intercalary resection for primary bone tumors. These are complex procedures and should be performed by an experienced team of surgeons who recognize that complications may occur frequently in the first years after the procedure. The frequency of mechanical complications observed in the first 5 years postoperatively may be lessened by using long spanning-plate fixation, and if successful, this reconstruction provides a long-term, durable reconstruction with excellent functional results. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Scanferla
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Serena Puccini
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Meyer University Hospital, Florence, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Cisanello University Hospital, Pisa, Italy
| | - Marco Innocenti
- Department of Plastic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Bangcoy MLS, Taniguchi Y, Morinaga S, Asano Y, Tsuchiya H. Graft Survivals after Reconstruction Using Tumor-Bearing Frozen Bone in the Extremities. Cancers (Basel) 2023; 15:3926. [PMID: 37568742 PMCID: PMC10417529 DOI: 10.3390/cancers15153926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Tumor-bearing frozen autografts have been widely used for reconstruction of bone defects caused by tumor resection. However, some patients undergo removal of the grafted bone due to surgical site infection, tumor recurrence, or fractures of the grafted bone. In this retrospective cohort study, predictive factors for graft survival were investigated in 123 patients who underwent reconstructions using a tumor-bearing frozen autograft after bone tumor resection of the extremities. To determine the independent predictors of graft survival, the association between various parameters and graft survival was investigated. The graft survival rates were 83.2% at 5 years and 70.2% at 10 years. Among the 123 frozen autografts, 25 (20.3%) were removed because of complications. In univariate analyses, male sex, BMI of ≥23.6, tibia, and chemotherapy were significantly associated with poor graft survival, whereas the pedicle/hemicortical freezing procedure was significantly associated with better graft survival. Multivariate analysis using the Cox proportional hazards regression model revealed that BMI of ≥23.6 (HR, 3.4; p = 0.005), tibia (HR, 2.3; p = 0.047), and freezing procedure (HR, 0.3; p = 0.016) were independently associated with graft survival. Based on the results, pedicle or hemicortical freezing techniques are recommended in cases where these techniques can be applied.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan
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Liu Q, Long F, Zhang C, Liu Y, He H, Luo W. Biological reconstruction of bone defect after resection of malignant bone tumor by allograft: a single-center retrospective cohort study. World J Surg Oncol 2023; 21:234. [PMID: 37525160 PMCID: PMC10388483 DOI: 10.1186/s12957-023-03121-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Allograft reconstruction following the resection of malignant bone tumors is associated with high rates of complications and failures. This study aimed to evaluate the efficacy and current problems of allograft reconstruction techniques to optimize treatment strategies at our center. MATERIALS AND METHODS Thirty-eight cases (16 men and 22 women), who were diagnosed with malignant bone tumors and had undergone allograft reconstruction, were recruited. Allograft was fixed by intramedullary nail, single steel plate, double plate, and intramedullary nail combined plate in 2, 4, 17, and 15 cases, respectively. Allograft union, local recurrence, and complications were assessed with clinical and radiological tests. Tumor grade was assessed using the Enneking staging of malignant bone tumors. Functional prognosis was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS Intercalary and osteoarticular reconstructions were performed in 32 and 6 cases, respectively. Six patients underwent reoperation related to allograft complications, four patients had local recurrence, and three patients with allograft fracture underwent allograft removal. A total of eight host-donor junctions showed nonunion, including seven cases (18.4%) in diaphysis and one case (3.1%) in metaphysis (p < 0.01). Host rejection and secondary osteoarthritis occurred in nine and two cases, respectively. No deep infection and internal fixation device fracture occurred. The overall allograft survival rate was 81.6%. Postoperative MSTS score of patients with allograft survival was 26.8 ± 2.9, indicating a significant improvement as compared to their preoperative function. CONCLUSIONS Allograft represents an excellent choice for intercalary bone defects after malignant bone tumor resection. Robust internal fixation protection across the whole length of the allograft is an important prerequisite for the survival of the allograft, while multidimensional osteotomy, intramedullary cement reinforcement, and pedicled muscle flap transfer can effectively improve the survival rate and healing rate of the allograft.
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Affiliation(s)
- Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Feng Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China.
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Hoftiezer YAJ, Posada Alvarez C, Werenski JO, Schreuder HWB, Eberlin KR, Lee SG, Lozano-Calderón SA. Salvage of a Fractured Proximal Ulnar Osteoarticular Allograft Using a Medial Femoral Condyle Free Flap: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00024. [PMID: 37531445 DOI: 10.2106/jbjs.cc.22.00796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
CASE We present the case of a 47-year-old paraplegic woman who underwent resection of an intermediate-grade chondrosarcoma in the proximal ulna, which was initially reconstructed with an osteoarticular allograft. However, after more than 25 years without complications, she sustained an intra-articular fracture of the allograft, which was then successfully treated using a vascularized medial femoral condyle (MFC) flap and anterolateral thigh flap. The patient has subsequently recovered her baseline elbow function, has no pain, and can use her wheelchair without restrictions. CONCLUSION Free MFC flaps are viable options to salvage osteoarticular allografts that are affected by intra-articular fractures.
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Affiliation(s)
- Yannick Albert J Hoftiezer
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolina Posada Alvarez
- Department of Orthopaedics, University Medical Center Groningen/University of Groningen, Groningen, the Netherlands
| | - Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - H W B Schreuder
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sang-Gil Lee
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Santiago A Lozano-Calderón
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Goldin AN, Johnson SR, Hajdu KS, Kowalski BL, Volkmar AJ, Moran CP, Rekulapelli A, Lawrenz JM, Halpern JL, Schwartz HS, Holt GE. Surgical Fixation Method in Lower Extremity Intercalary Allograft Reconstruction After Oncologic Resection: A Comparison of Plates and Nails. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00725. [PMID: 37311442 DOI: 10.5435/jaaos-d-23-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Fixation in intercalary allograft reconstruction includes plates and intramedullary nails. The purpose of this study was to examine rates of nonunion, fracture, the overall need for revision surgery, and allograft survival based on the surgical fixation method in lower extremity intercalary allografts. METHODS A retrospective chart review was performed on 51 patients with intercalary allograft reconstruction in the lower extremity. Fixation methods compared were intramedullary fixation with nails (IMN) and extramedullary fixation with plates (EMP). Complications compared were nonunion, fracture, and wound complications. The alpha was set at 0.05 for statistical analysis. RESULTS Nonunion incidence at all allograft-to-native bone junction sites was 21% (IMN) and 25% (EMP) (P = 0.8). Fracture incidence was 24% (IMN) and 32% (EMP) (P = 0.75). Median fracture-free allograft survival was 7.9 years (IMN) and 3.2 years (EMP) (P = 0.04). Infection was seen in 18% (IMN) and 12% (EMP) (P = 0.7). The overall need for revision surgery was 59% (IMN) and 71% (EMP) (P = 0.53). Allograft survival at the final follow-up was 82% (IMN) and 65% (EMP) (P = 0.33). When the EMP group was subdivided into single plate (SP) and multiple plate (MP) groups and compared with the IMN groups, fracture rates were 24% (IMN), 8% (SP), and 48% (MP) (P = 0.04). Rates of revision surgery were 59% (IMN), 46% (SP), and 86% (MP) (P = 0.04). Allograft survival at the final follow-up was 88% (IMN), 92% (SP), and 52% (MP) (P = 0.05). DISCUSSION Median fracture-free allograft survival was notably longer for the IMN group than the EMP group; otherwise, there were no notable differences between the intramedullary and extramedullary groups. When the EMP group was subdivided into the SP and MP groups, patients with MPs had higher rates of fracture, higher rates of revision surgery, and lower overall allograft survival. LEVEL OF EVIDENCE III, Therapeutic Study, Retrospective Comparative Study.
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Affiliation(s)
- Amanda N Goldin
- From the Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Goldin, Johnson, Hajdu, Kowalski, Volkmar, Moran, Rekulapelli, Lawrenz, Halpern, Schwartz, and Holt), and the Department of Orthopaedics, University of California, Irvine, CA (Goldin)
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Liang H, Yang Y, Guo W, Yan L, Tang X, Li D, Qu H, Zang J, Du Z. Elbow hemiarthroplasty with a 3D-printed megaprosthesis for defects of the distal humerus or proximal ulna after tumour resection : a preliminary report. Bone Joint J 2022; 104-B:747-757. [PMID: 35638204 DOI: 10.1302/0301-620x.104b6.bjj-2021-1516.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection. METHODS From June 2018 to January 2020, 13 patients with aggressive or malignant tumours involving the distal humerus (n = 8) or proximal ulna (n = 5) were treated by en bloc resection and reconstruction with a 3D-printed megaprosthesis with hemiarthroplasty, designed in our centre. In this paper, we summarize the baseline and operative data, oncological outcome, complication profiles, and functional status of these patients. RESULTS Preparation of the prosthesis was a mean of 8.0 days (SD 1.5), during which time no patients experienced tumour progression. The mean operating time and intraoperative blood loss were 158.1 minutes (SD 67.6) and 176.9 ml (SD 187.8), respectively. All of the prostheses were implanted successfully. During a mean follow-up of 25.7 months (SD 7.8), no patients died, but four had complications (two superficial wound problems, one temporary palsy of radial nerve, and one dislocation). No aseptic loosening, structural failure, infection, heterotopic ossification, or degenerative arthritis was seen in this study. The mean flexion of the elbow was 119.6° (SD 15.9°) and the mean extension lag was 11.9° (SD 13.8°). The mean Musculoskeletal Tumor Society 93 score and Mayo Elbow Performance Score were 28.4 (SD 0.9) and 97.7 (SD 4.4), respectively. CONCLUSION The custom-made, 3D-printed megaprosthesis with hemiarthroplasty is a feasible option for functional reconstruction after resection of a tumour in the distal humerus or proximal ulna. Cite this article: Bone Joint J 2022;104-B(6):747-757.
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Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Liang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Dasen Li
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Jie Zang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
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9
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Ebeid WA, Eldaw S, Badr IT, Mesregah MK, Hasan BZ. Outcomes of modular endoprosthesis reconstruction versus cement spacer reconstruction following resection of proximal humeral tumors. BMC Musculoskelet Disord 2022; 23:484. [PMID: 35597987 PMCID: PMC9123671 DOI: 10.1186/s12891-022-05432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no agreement about the best reconstructive option following resection of proximal humerus tumors. The purpose of this study was to compare the functional outcomes of endoprosthesis reconstruction versus nail cement spacer reconstruction after wide resection of proximal humeral tumors. METHODS This retrospective comparative study included 58 patients with proximal humerus tumors who had undergone tumor resection and reconstruction with modular endoprosthesis (humeral hemiarthroplasties) or cement spacer. Medical records were reviewed for the epidemiological, clinical, radiological, and operative data. Lung metastasis, local recurrence, and complication were also reviewed. The functional outcome was evaluated using the Musculoskeletal Tumor Society scoring (MSTS) system. RESULTS Nineteen patients with a mean age of 33.4 ± 17.5 years underwent reconstruction by modular endoprosthesis, and 39 patients with a mean age of 24.6 ± 14.3 years underwent reconstruction by cement spacer. The mean MSTS score was 24.8 ± 1.1 in the endoprosthesis group and 23.9 ± 1.4 in the spacer group, P = 0.018. Complications were reported in 5 (26.3%) patients in the endoprosthesis group and 11 (28.2%) patients in the spacer group, P = 0.879. There were no statistically significant differences in the functional outcomes in both patient groups with or without axillary or deltoid resection. CONCLUSIONS Both endoprostheses and cement spacers are durable reconstructions with almost equal functional outcomes with no added advantage of the expensive endoprosthesis.
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Affiliation(s)
- Walid Atef Ebeid
- Department of Orthopaedic Surgery, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Sherif Eldaw
- Department of Orthopaedic Surgery, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt.
| | - Bahaa Zakarya Hasan
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
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Hopyan S. Reconstruction for bone tumours of the shoulder and humerus in children and adolescents. J Child Orthop 2021; 15:358-365. [PMID: 34476025 PMCID: PMC8381401 DOI: 10.1302/1863-2548.15.210131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023] Open
Abstract
Reconstructions for paediatric bone tumours of the shoulder girdle and humerus are intended to optimize placement of the hand in space. Given the longevity of paediatric survivors of sarcoma, durability is an important planning consideration. Here, I review a subset of approaches based on anatomical site with an emphasis on function and longevity. Often, biological reconstructions that combine living bone with tendon repairs and transfers best address those goals.
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Affiliation(s)
- Sevan Hopyan
- Division of Orthopaedics and Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto,Division of Orthopaedics, Department of Surgery and Department of Molecular Genetics, University of Toronto,Correspondence should be sent to Sevan Hopyan, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. E-mail:
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Li M, Xiao X, Fan J, Lu Y, Chen G, Huang M, Ji C, Wang Z, Li J. Is the Capanna Technique a Reliable Method for Revision Surgery after Failure of Previous Limb-Salvage Surgery? Ann Surg Oncol 2021; 29:1122-1129. [PMID: 34341889 DOI: 10.1245/s10434-021-10506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reconstruction of a massive bone defect caused by previous failed limb-salvage surgery in patients with bone sarcoma is challenging. Many procedures have been used, but they all have their inherent disadvantages. The Capanna technique has demonstrated good functional outcomes and a low incidence of complications in primary reconstructive surgery of massive bone defect. However, few studies have focused on its usage in revision surgery after failed primary limb-salvage surgery. METHODS Between June 2011 and January 2017, 13 patients underwent revision surgery with the Capanna technique for reconstruction of a secondary segmental bone defect caused by a previous failed surgical procedure. The demographics, operating procedures, graft union, functional outcomes, oncologic outcomes, and postoperative complications of each patient were recorded. RESULTS The current study investigated 13 patients. The rate of limb salvage was 100 %. Bone union was achieved for all patients during a mean time of 8.54 ± 2.15 months (range 4-11 months) at the fibula-host bone junction and 14.92 ± 2.33 months (range 12-21 months) at the allograft-host bone junction. The postoperative complications included wound healing issues and internal fixation loosening. Allograft fracture, nonunion, and infection were not observed. All the patients achieved good functional outcomes, with a Musculoskeletal Tumor Society (MSTS) score of 0.86 ± 0.03 at the latest follow-up visit. CONCLUSIONS The Capanna technique is a reliable alternative method for revision reconstruction of a segmental bone defect caused by a previous failed surgical procedure. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Minghui Li
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Xin Xiao
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Junjun Fan
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Yajie Lu
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Guojing Chen
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Mengquan Huang
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Chuanlei Ji
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Zhen Wang
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Jing Li
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Xi'an, Shaanxi, People's Republic of China.
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Beltrami G, Nucci AM, Tamburini A, Innocenti M. Custom-made 3D-printed prosthesis and free vascularised fibula for humeral reconstruction after osteosarcoma resection in a 13-year-old patient. BMJ Case Rep 2021; 14:14/5/e240726. [PMID: 34045194 PMCID: PMC8162075 DOI: 10.1136/bcr-2020-240726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic oncology. Particularly in paediatric patients, the main concerns are maintaining limb function and reconstruction longevity. We describe a novel strategy of humeral reconstruction based on the use of a three-dimensional-printed custom-made prosthesis in a 13-year-old patient diagnosed with osteosarcoma. The implant was specifically designed to sustain the native head, which was spared, as it was not involved by the neoplastic tissue. The mechanical support the prosthesis provided was associated with the biological stimulus of a free vascularised fibular graft to obtain an anatomic, functional and stable construct. This solution has had good longevity, and after 3 years of follow-up, the patient still shows excellent limb function and personal satisfaction.
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Affiliation(s)
- Giovanni Beltrami
- Department of Pediatric Orthopedics and Pediatric Orthopedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Firenze, Italy
| | - Anna Maria Nucci
- Department of Orthopedics and Traumatology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy
| | - Angela Tamburini
- Department of Pediatric Onco-Hematology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Firenze, Italy
| | - Marco Innocenti
- Department of Plastic Surgery and Microsurgery, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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Zha Y, Hua K, Gong M, Jiang X. Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report. BMC Musculoskelet Disord 2021; 22:338. [PMID: 33827519 PMCID: PMC8028123 DOI: 10.1186/s12891-021-04199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic intercondylar fractures of the distal humerus with massive bone defects and severe comminution in the metaphysis are rare and complex injuries that are challenging for surgeons to treat, as reconstructing the triangular structure of the distal humerus is difficult and may have a severe impact on functional outcomes, especially in young patients, for whom total elbow arthroplasty is usually not a suitable option due to significant impairment in upper limb strength. Here, we report a patient in such scenario who was young and active and was treated by structural iliac bone autografting and internal fixation. Case presentation A 26-year-old male patient experienced a major car accident and was diagnosed with an open fracture (Gustilo-Anderson type IIIB) of the right distal humerus with massive bone defects and severe intra-articular involvement, without neurovascular injuries or other associated injuries. Surgical debridement, negative pressure vacuum sealing drainage, and immobilization by braces were initially performed, and the wound was closed after 15 days. When the wound had finally healed and the soft tissue was in good condition without infection or effusion 45 days later, this young and active patient was diagnosed with a chronic type C3 distal humeral fracture associated with massive bone defects at the supracondylar level in both columns and severe comminution at the trochlear groove. We performed surgical debridement and arthrolysis around the fracture site, and then, we successfully reconstructed the triangular structure of the distal humerus using structural iliac crest autografts in both columns as well as in the defective trochlear groove. Finally, internal fixation via a parallel double-plate configuration was performed. Over a follow-up period of 3 years, the patient achieved almost full recovery of range of motion and an excellent functional score, without minor or major postoperative complications. Conclusion In this study, we proposed a surgical reconstruction strategy for complex chronic distal humeral fractures associated with massive bone defects and severe articular involvement in young and active patients using metaphyseal shortening and structural iliac crest bone autografting together with open reduction and internal fixation via a parallel configuration.
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Affiliation(s)
- Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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15
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Vascular Endothelial Growth Factor and Mesenchymal Stem Cells Revealed Similar Bone Formation to Allograft in a Sheep Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6676609. [PMID: 33763484 PMCID: PMC7946458 DOI: 10.1155/2021/6676609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
Introduction Mesenchymal stem cells (MSCs) and vascular endothelial growth factor (VEGF) are key factors in bone regeneration. Further stimulation should establish an enhanced cell environment optimal for vessel evolvement and hereby being able to attract bone-forming cells. The aim of this study was to generate new bone by using MSCs and VEGF, being able to stimulate growth equal to allograft. Methods Eight Texel/Gotland sheep had four titanium implants in a size of 10 × 12 mm inserted into bilateral distal femurs, containing a 2 mm gap. In the gap, autologous 3 × 106 MSCs seeded on hydroxyapatite (HA) granules in combination with 10 ng, 100 ng, and 500 ng VEGF release/day were added. After 12 weeks, the implant-bone blocks were harvested, embedded, and sectioned for histomorphometric analysis. Bone formation and mechanical fixation were evaluated. Blood samples were collected for the determination of bone-related biomarkers and VEGF in serum at weeks 0, 1, 4, 8, and 12. Results The combination of 3 × 106 MSCs with 10 ng, 100 ng, and 500 ng VEGF release/day exhibited similar amount of bone formation within the gap as allograft (P > 0.05). Moreover, no difference in mechanical fixation was observed between the groups (P > 0.05). Serum biomarkers showed no significant difference compared to baseline (all P > 0.05). Conclusion MSCs and VEGF exhibit significant bone regeneration, and their bone properties equal to allograft, with no systemic increase in osteogenic markers or VEGF with no visible side effects. This study indicates a possible new approach into solving the problem of insufficient allograft, in larger bone defects.
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Tarpada SP, Goch AM, Loloi J, Sen MK. Salvage of a recalcitrant humeral shaft septic nonunion using a linked nail-plate fixation construct with intercalary allograft. Trauma Case Rep 2021; 32:100427. [PMID: 33665320 PMCID: PMC7900758 DOI: 10.1016/j.tcr.2021.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/30/2022] Open
Abstract
Open humeral shaft fractures comprise approximately 2% of all fractures of the humerus. Nearly 20% of open humeral shaft fractures will develop deep infection, increasing the risk of nonunion regardless of treatment method. Recalcitrant septic nonunion of the humeral shaft is a complex and challenging problem. Operative treatment should aim to eradicate infection, address bony defects, and establish a stable construct that affords early motion. We describe the case of a 38-year-old male with a recalcitrant humeral shaft septic nonunion following fixation of an open humeral shaft fracture. Management of the infection consisted of periodic surgical debridement and IV antibiotics, resulting in a 10 cm segmental defect. Definitive fixation was achieved using the combination of an antegrade intramedullary nail, intercalary femoral shaft allograft, compression plating, and autologous bone graft. In addition to achieving bony union, the patient regained his pre-injury ROM and function, which was clinically sustained at 2-year follow-up.
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Affiliation(s)
- Sandip P Tarpada
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.,Department of Orthopedic Surgery, Jacobi Medical Center, NYCHHC, Bronx, NY, United States of America
| | - Abraham M Goch
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.,Department of Orthopedic Surgery, Jacobi Medical Center, NYCHHC, Bronx, NY, United States of America
| | - Jeremy Loloi
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.,Department of Orthopedic Surgery, Jacobi Medical Center, NYCHHC, Bronx, NY, United States of America
| | - Milan K Sen
- Department of Orthopedic Surgery, Jacobi Medical Center, NYCHHC, Bronx, NY, United States of America
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17
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Boileau P, Raynier JL, Chelli M, Gonzalez JF, Galvin JW. Reverse shoulder-allograft prosthesis composite, with or without tendon transfer, for the treatment of severe proximal humeral bone loss. J Shoulder Elbow Surg 2020; 29:e401-e415. [PMID: 32713667 DOI: 10.1016/j.jse.2020.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer. METHODS An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reverse stem and a "mirror step-cut osteotomy," without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L'Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years). RESULTS Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045). CONCLUSIONS (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L'Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reverse stem with mirror step-cut osteotomy provides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.
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Affiliation(s)
- Pascal Boileau
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France.
| | - Jean-Luc Raynier
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | - Mikaël Chelli
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | | | - Joseph W Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Lammens J, Maréchal M, Delport H, Geris L, Oppermann H, Vukicevic S, Luyten FP. A cell-based combination product for the repair of large bone defects. Bone 2020; 138:115511. [PMID: 32599225 DOI: 10.1016/j.bone.2020.115511] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 01/19/2023]
Abstract
Regenerative cell-based implants using periosteum-derived stem cells were developed for the treatment of large 3 cm fresh and 4.5 centimeter biological compromised bone gaps in a tibial sheep model and compared with an acellular ceramic-collagen void filler. It was hypothesized that the latter is insufficient to heal large skeletal defects due to reduced endogenous biological potency. To this purpose a comparison was made between the ceramic dicalciumphosphate scaffold (CopiOs®) as such, the same ceramic coated with clinical grade Bone Morphogenetic Protein 2 and 6 (BMP) only or a BMP coated cell-seeded combination product. These implants were evaluated in 2 sheep models, a fresh 3 cm critical size tibial defect and a 4.5 cm biologically exhausted tibial defect. For the groups in which growth factors were applied, BMP-6 was chosen at a dose of 344 μg for 3 cm and 1.500 μg or 3.800 μg for 4.5 cm defects. An additional group in the 4.5 cm defect was tested using BMP-2 in a dose of 1.500 μg. For all the cell based implants autologous periosteum-derived cells were used which were cultured in monolayer during 6 weeks. For the fresh defect 408 million cells and for the biologically exhausted tibial defect 612 million cells were drop-seeded on the BMP coated scaffolds. Bone healing was studied during 16 weeks postimplantation, using standard radiographs. While fresh defects responded to all treatments, regardless the use of cells, the biologically hampered defects responded in half of the cases and only if the BMP-cell combination product was used, supporting the concept that cell-based therapies may become attractive in treating defects with a compromised biological status.
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Affiliation(s)
- Johan Lammens
- Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Prometheus, Division of Skeletal Tissue Engineering of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Marina Maréchal
- Prometheus, Division of Skeletal Tissue Engineering of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Skeletal Biology and Engineering Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hendrik Delport
- Prometheus, Division of Skeletal Tissue Engineering of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Liesbet Geris
- Prometheus, Division of Skeletal Tissue Engineering of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Skeletal Biology and Engineering Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Celestijnenlaan 300, 3001 Heverlee (Leuven), Belgium; Biomechanics Research Unit, GIGA In silico medicine, University of Liège, Quartier Hôpital, Avenue de l'Hôpital 1, 4000 Liège 1, Belgium
| | - Hermann Oppermann
- Genera Research, Svetonedeljska cesta 2, 10436 Kalinovica, Sveta Nedelja, Croatia
| | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Šalata ul. 2, 10000 Zagreb, Croatia
| | - Frank P Luyten
- Prometheus, Division of Skeletal Tissue Engineering of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Skeletal Biology and Engineering Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Yao W, Cai Q, Wang J, Hou J. Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri. World J Surg Oncol 2020; 18:23. [PMID: 31996228 PMCID: PMC6990589 DOI: 10.1186/s12957-020-1797-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background The proximal humerus is one of the most common sites of primary or metastatic malignant tumors. Reconstruction of the shoulder after tumor resection is controversial and challenging. When intra-articular resection is performed, biological reconstruction (osteoarticular allograft and autologous bone implantation) may be the first choice rather than prosthetic reconstruction. Objective To observe the mid- to long-term effects of oncologic, reconstructive, and functional outcomes of two different biological reconstruction methods for resection of humerus osteosarcoma involving caput humeri. Methods This was a retrospective study of 13 consecutive patients who underwent humeral reconstruction of osteosarcoma including caput humeri using osteoarticular allograft (n = 7) and tumor bone inactivated and reimplantation (TBIR, n = 6) in our clinic between 2007 and 2017. Patients’ general information, resection and reconstruction techniques, oncological and functional outcomes, and complications were collected and evaluated. Different complications of implantations were compared and analyzed for the different biological methods. Results The study included ten males and three females with an average age of 19.15 years. The operation time was about 3.65 h with an average blood loss of 631 ml. The resection tumor bones were 13–45 cm (23.54 cm on average). The mean follow-up period was 5.27 years. The shoulder movement was 10–70° (average, 44.00°) in abduction, 0–30° (average, 14.17°) in flexion, and 0–20° (average, 11.90°) in extention at the last follow-up. The complications included fracture in four TBIR patients and two allograft patients with an average of 2.67 years postoperation. Fracture rate was higher and appeared time was earlier in TBIR patients than in allograft patients (p = 0.04); caput humeri absorption occurred in all seven allograft patients and three TBIR patients at an average of 3.10 years after surgery; severe graft bone resorption appeared in five TBIR patients and two allograft patients at an average of 2.57 years of follow-up. Conclusions Humerus biological reconstruction involving caput humeri was associated with a high complication rate and acceptable limb function in the mid to long term. New combined biological methods should be explored and adopted in the future.
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Affiliation(s)
- Weitao Yao
- Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, 45000, People's Republic of China.
| | - Qiqing Cai
- Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, 45000, People's Republic of China
| | - Jiaqiang Wang
- Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, 45000, People's Republic of China
| | - Jingyu Hou
- Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, 45000, People's Republic of China
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