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Jain N, Campano D, Gottlich C, Yu A, Brindley G, Callan A, Blank A. Total Humeral Endoprosthetic Reconstruction: A Systematic Review. Orthopedics 2024; 47:e106-e113. [PMID: 38690850 DOI: 10.3928/01477447-20240424-01] [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] [Indexed: 05/03/2024]
Abstract
BACKGROUND Total humeral endoprosthetic reconstruction (THER) is a rare reconstruction option for limb salvage surgery for large humeral neoplasms or bone destruction. MATERIALS AND METHODS Because of the limited data and need for this procedure, we reviewed the literature surrounding THER and assessed functionality, complications, and revisions using the PubMed, Embase, Ovid, and Scopus databases. RESULTS Among 29 articles and 175 patients, the most common indication was neoplasm (n=25, 86%), mean follow-up was 61.98 months (SD=55.25 months), and mean Musculoskeletal Tumor Society score was 73.64% (SD=10.69%). Reported complications included 26 (23%) revisions in 7 studies, 35 (36%) cases of shoulder instability in 7 studies, and 13 (13.54%) cases of deep infection in 4 studies. CONCLUSION THER should be considered with a thorough knowledge of outcomes and potential complications to guide patient and clinician expectations. [Orthopedics. 2024;47(3):e106-e113.].
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Gonzalez MR, Werenski JO, Lozano-Calderon SA. Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb: A Systematic Review of the Literature. JBJS Rev 2024; 12:01874474-202405000-00006. [PMID: 38768282 DOI: 10.2106/jbjs.rvw.24.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Total humerus replacement (THR) is a reconstruction procedure performed after resection of massive humeral tumors. However, there is limited literature on the rates of failure and functional outcomes of this implant. Our study aimed to determine the main failure modes, implant survival, and postoperative functional outcomes of THR. METHODS A comprehensive search of the PubMed and Embase databases was conducted. We registered our study on PROSPERO (448684) and used the Strengthening the Reporting of Observational Studies in Epidemiology checklist for quality assessment. The Henderson classification was used to assess endoprosthesis failure and the Musculoskeletal Tumor Society (MSTS) score for functional outcomes. Weighted means and standard deviations were calculated. RESULTS Ten studies comprising 171 patients undergoing THR were finally included. The overall failure rate was 32.2%. Tumor progression (12.6%) and prosthetic infections (9.4%) were the most common failure modes, followed by soft-tissue failures (5.9%), aseptic loosening (3.5%), and structural failure (1.8%). Two-year, 5-year, and 10-year implant survival rates for the entire cohort were 86%, 81%, and 69.3%. Ten-year implant survival for primary THRs was 78.3%, compared with 38.6% for revision THRs (p = 0.049). The mean MSTS score at the last follow-up was 77%. Patients whose implants did not fail had a higher MSTS score (79.3%) than those with failed implants (71.4%) (p = 0.02). CONCLUSION One-third of THR will fail, mostly due to tumor progression and prosthetic infection. Overall functional scores were acceptable, with MSTS scores displaying great hand and elbow function but limited shoulder function. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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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, Massachusetts
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Pareatumbee P, Zainul-Abidin S, Yew A, Chou SM, Howe TS, Koh JSB, Tan MH. Effect of implant length variations on stress shielding in proximal humeral replacement after tumor excision under torsion: Finite element study. J Orthop Res 2022; 41:1139-1147. [PMID: 36200541 DOI: 10.1002/jor.25456] [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] [Received: 06/19/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
The proximal humerus is the most common site of occurrence of primary bone tumors in the upper limb. Endoprosthetic replacement is deemed as the preferred reconstructive option following primary resection of bone tumors. However, it has been also associated with complications such as stress shielding and aseptic loosening compromising prosthetic survival. Our objective was to conduct a finite element (FE) study to investigate the effect of varying endoprosthesis length on bone stresses as well as to quantify the extent of stress shielding across the bone length (BL) in a humerus-prosthesis assembly for proximal humeral replacement after tumor excision thereby allowing us to identify the optimal implant length with best biomechanical performance. FE models of the intact humerus and humerus-prosthesis assemblies were established where they were loaded at the elbow joint under torsion with the glenohumeral joint fixed to represent twisting. After dividing the bone into individual slices consisting of 5% BL, the maximum cortical and cancellous principal, von Mises and shear bone stresses were calculated. To measure the level of stress shielding, the percentage stress change from the intact state was evaluated across each slice. Similar stress patterns were observed between the intact state and shorter endoprosthesis compared to the longer endoprostheses. Our findings illustrated the possibility of stress shielding occurring under torsional forces with its effect increasing with implant lengthening. To conclude, we believe that using a shorter prosthesis may substantially diminish the risk of potential implant failure due to stress shielding.
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Affiliation(s)
- Pivatidevi Pareatumbee
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore
| | - Suraya Zainul-Abidin
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Siaw M Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tet Sen Howe
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Joyce S B Koh
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
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Fiore M, Sambri A, Giannini C, Zucchini R, De Cristofaro R, De Paolis M. Anatomical and reverse megaprosthesis in proximal humerus reconstructions after oncologic resections: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:2459-2469. [PMID: 33721053 DOI: 10.1007/s00402-021-03857-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
AIM Anatomic (AN) Endoprosthesis (EPR) reconstructions of the shoulder after intra-articular proximal humerus (Malawer type 1) resections are characterized by early recovery and low complications rate. However, shoulder instability and limited mobility can occur. Reverse shoulder (RS) EPR has been introduced to improve functional outcome. The aim of this systematic review is to evaluate shoulder reconstructions with AN or RS EPR after Malawer type 1 resection, comparing complications and functional results. METHODS Through an electronic systematic search of PubMed, articles concerning EPR after shoulder Malawer type 1 resections were reviewed. Complications rate, range of motion (ROM) and functional outcome (Musculoskeletal Society Tumor Society-MSTS score) of AN and RS EPR were evaluated. RESULTS Sixteen studies were included. A similar complication rate was observed between AN and RS EPR rate (26.4% and 22.4%, respectively, p = 0.37). Soft tissue failure was the most frequent complication and cause of revision in both groups. Mean post-operative flexion and abduction ROM and MSTS scores were significantly higher in RS EPR, particularly among patients with preserved deltoid function (p = 0.013, p = 0.025 and p = 0.005, respectively). CONCLUSIONS Anatomic and reverse shoulder EPR represent safe and effective implants for shoulder reconstruction, with similar implant stability and complication rates. RS EPR significantly improves post-operative ROM and functional outcomes, especially when at least a partial function of the abductor apparatus is preserved.
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Affiliation(s)
- Michele Fiore
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy. .,IRCCS Policlinico di Sant'Orsola, Bologna, Italy.
| | - Claudio Giannini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Riccardo Zucchini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
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5
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Mengers SRP, Knapik DM, Strony J, Nelson G, Faxon E, Renko N, Getty P, Gillespie R. The Use of Tumor Prostheses for Primary or Revision Reverse Total Shoulder Arthroplasty With Proximal Humeral Bone Loss. J Shoulder Elb Arthroplast 2022; 6:24715492211063108. [PMID: 35669621 PMCID: PMC9163720 DOI: 10.1177/24715492211063108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS (P = .03) and ASES score (P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.
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Affiliation(s)
- Sunita RP Mengers
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - John Strony
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Grant Nelson
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Evan Faxon
- The College of Wooster, Wooster, OH, USA
| | - Nellie Renko
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Patrick Getty
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gillespie
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
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Theil C, Schwarze J, Gosheger G, Moellenbeck B, Schneider KN, Deventer N, Klingebiel S, Grammatopoulos G, Boettner F, Schmidt-Braekling T. Implant Survival, Clinical Outcome and Complications of Megaprosthetic Reconstructions Following Sarcoma Resection. Cancers (Basel) 2022; 14:cancers14020351. [PMID: 35053514 PMCID: PMC8773828 DOI: 10.3390/cancers14020351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Malignant bone and soft tissue tumors are usually surgically removed with an envelope of healthy tissue as a barrier. If located in the long bones of the upper and lower extremity, this approach leads to a large bone defect commonly affecting a joint. One way to rebuild the bone defect and the neighboring joint is the use of a megaprosthesis that is anchored in the remaining bone comparable to a conventional joint replacement. In general this approach is popular as it provides early stability and allows the affected patient to begin rehabilitation early on. However, complications leading to long-term unplanned reoperation are common. This article provides an overview of current implant survival, types of complication and long-term outcomes of megaprostheses used following tumor resection. Abstract Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions.
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Affiliation(s)
- Christoph Theil
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Jan Schwarze
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Georg Gosheger
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Burkhard Moellenbeck
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Kristian Nikolaus Schneider
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Niklas Deventer
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - Sebastian Klingebiel
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA;
| | - Tom Schmidt-Braekling
- Department for General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (C.T.); (J.S.); (G.G.); (B.M.); (K.N.S.); (N.D.); (S.K.)
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;
- Correspondence:
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7
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Schneider KN, Bröking JN, Gosheger G, Lübben T, Hardes J, Schorn D, Smolle MA, Theil C, Andreou D. What Is the Implant Survivorship and Functional Outcome After Total Humeral Replacement in Patients with Primary Bone Tumors? Clin Orthop Relat Res 2021; 479:1754-1764. [PMID: 33595237 PMCID: PMC8277276 DOI: 10.1097/corr.0000000000001677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total humeral replacement is an option to reconstruct massive bone defects after resection of locally advanced bone tumors of the humerus. However, implant survivorship, potential risk factors for implant revision surgery, and functional results of total humeral replacement are poorly elucidated because of the rarity of the procedure. QUESTIONS/PURPOSES We asked: (1) What is the revision-free implant and overall limb survivorship after total humerus replacement? (2) What factors are associated with implant revision surgery? (3) What is the functional outcome of the procedure as determined by the Musculoskeletal Tumor Society (MSTS) score and the American Shoulder and Elbow Surgeons (ASES) score? METHODS Between August 1999 and December 2018, 666 patients underwent megaprosthetic reconstruction after resection of a primary malignant or locally aggressive/rarely metastasizing tumor of the long bones at our department. In all, 23% (154) of these patients had a primary tumor located in the humerus. During the study, we performed total humeral replacement in all patients with a locally advanced sarcoma, in patients with pathological fractures, in patients with skip metastases, or in patients with previous intralesional contaminating surgery, who would have no sufficient bone stock for a stable implant fixation for a single joint megaprosthetic replacement of the proximal or distal humerus. We performed no biological reconstructions or reconstructions with allograft-prosthetic composites. As a result, 5% (33 of 666) of patients underwent total humerus replacement. Six percent (2 of 33) of patients were excluded because they received a custom-made, three-dimensionally (3-D) printed hemiprosthesis, leaving 5% (31) of the initial 666 patients for inclusion in our retrospective analysis. Of these, 6% (2 of 31) had surgery more than 5 years ago, but they had not been seen in the last 5 years. Median (interquartile range) age at the time of surgery was 15 years (14 to 25 years), and indications for total humeral replacement were primary malignant bone tumors (n = 30) and a recurring, rarely metastasizing bone tumor (n = 1). All megaprosthetic reconstructions were performed with a single modular system. The implanted prostheses were silver-coated beginning in 2006, and beginning in 2010, a reverse proximal humerus component was used when appropriate. We analyzed endoprosthetic complications descriptively and assessed the functional outcome of all surviving patients who did not undergo secondary amputation using the 1993 MSTS score and the ASES score. The median (IQR) follow-up in all survivors was 75 months (50 to 122 months), with a minimum follow-up period of 25 months. We evaluated the following factors for possible association with implant revision surgery: age, BMI, reconstruction length, duration of surgery, extraarticular resection, pathological fracture, previous intralesional surgery, (neo-)adjuvant radio- and chemotherapy, and metastatic disease. RESULTS The revision-free implant survivorship at 1 year was 77% (95% confidence interval 58% to 89%) and 74% (95% CI 55% to 86%) at 5 years. The overall limb survivorship was 93% (95% CI 75% to 98%) after 1 and after 5 years. We found revision-free survivorship to be lower in patients with extraarticular shoulder resection compared with intraarticular resections (50% [95% CI 21% to 74%] versus 89% [95% CI 64% to 97%]) after 5 years (subhazard ratios for extraarticular resections 4.4 [95% CI 1.2 to 16.5]; p = 0.03). With the number of patients available for our analysis, we could not detect a difference in revision-free survivorship at 5 years between patients who underwent postoperative radiotherapy (40% [95% CI 5% to 75%]) and patients who did not (81% [95% CI 60% to 92%]; p = 0.09). The median (IQR) MSTS score in 9 of 13 surviving patients after a median follow-up of 75 months (51 to 148 months) was 87% (67% to 92%), and the median ASES score was 83 (63 to 89) of 100 points, with higher scores representing better function. CONCLUSION Total humeral replacement after resection of locally advanced bone tumors appears to be associated with a good functional outcome in patients who do not die of their tumors, which in our study was approximately one- third of those who were treated with a resection and total humerus prosthesis. However, the probability of early prosthetic revision surgery is high, especially in patients undergoing extraarticular resections, who should be counseled accordingly. Still, our results suggest that if the prosthesis survives the first year, further risk for revision appears to be low. Future studies should reexamine the effect of postoperative radiotherapy on implant survival in a larger cohort and evaluate whether the use of soft tissue coverage with plastic reconstructive surgery might decrease the risk of early revisions, especially in patients undergoing extraarticular resections. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | - Jan Niklas Bröking
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Timo Lübben
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Jendrik Hardes
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Dominik Schorn
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
| | - Dimosthenis Andreou
- Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Muenster, Germany
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8
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Fourman MS. CORR Insights®: What Is the Implant Survivorship and Functional Outcome After Total Humeral Replacement in Patients with Primary Bone Tumors? Clin Orthop Relat Res 2021; 479:1765-1767. [PMID: 33739330 PMCID: PMC8277275 DOI: 10.1097/corr.0000000000001732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Mitchell S Fourman
- Orthopaedic Oncology Service, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA
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9
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Bernthal NM, Upfill-Brown A, Burke ZD, Greig D, Hwang R, Crawford B, Eckardt JJ. Long term outcomes of total humeral replacement for oncological reconstructions: A single institution experience. J Surg Oncol 2020; 122:778-786. [PMID: 32602118 PMCID: PMC11037129 DOI: 10.1002/jso.26080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data on long-term survivorship and outcomes for total humerus replacements (THR) with only two series reporting 10-year survival. PATIENTS AND METHODS A review of 769 consecutive, prospectively collected endoprosthetic reconstructions for oncological diagnoses at a single-center between 1980 and 2019 was performed. Patients with THRs were isolated and analyzed for outcomes, complications, and modes of failure. RESULTS Eighteen patients with 20 THR implants were identified. The median follow-up for surviving patients was 148 months (interquartile range [IQR] = 74-194) and 60 months (IQR = 17-155 months) for all patients. Two prostheses required revision for failure, both for symptomatic shoulder dislocation. There were three local recurrences. Revision-free survival at 5, 10, and 15 years was 100%, 86% and 86%, respectively. There were no cases of ulnar component failure, radial nerve palsy, or periprosthetic infection. CONCLUSIONS THR prosthesis survivorship is comparable to the previous series, with a longer follow-up than has previously been reported. Symptomatic shoulder instability was common (25%), and was the only cause of revision. Reverse total shoulder could be an important way to address this in the future. Local recurrence rates were high, as has been reported elsewhere for THR.
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Affiliation(s)
- Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Zachary D.C. Burke
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Danielle Greig
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Richard Hwang
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Brooke Crawford
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey J. Eckardt
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
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Abstract
In 1943, Austin Moore successfully reconstructed a proximal femur using a Vitallium endoprosthesis. This marked the first successful alternative to amputation in oncologic surgery. However, it was not until the introduction of high-resolution axial imaging and improved chemotherapeutics that the feasibility of limb salvage began to improve. Today, limb salvage surgery can be used to treat most oncologic conditions of the extremities, the most popular reconstruction option being endoprostheses. Megaprostheses use has expanded to nononcologic indications with severe bone loss, including infections, revision arthroplasty, and severe periarticular trauma and its sequelae. The proximal humerus and scapula are challenging for reconstruction, given the complex anatomy of the brachial plexus, the accompanying vascular structures, and the dynamic stabilizers of the relatively nonstable glenohumeral joint. The midhumerus is difficult because of the close location of the radial nerve, whereas the distal humerus is challenging because of the proximity of the brachial artery and its bifurcation, radial, ulnar, and median nerves, and lack of soft-tissue coverage. Despite these challenges, this review demonstrates that many series show excellent mid- to long-term results for pain relief and function restoration after megaprosthetic reconstruction of the scapula and humerus after bone resections for oncologic and nononcologic reasons.
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11
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Patino JM, Ramos Vertiz AJ. Hydatidosis of the complete humerus. Treated with radical resection and endoprosthesis. Case report. Int J Surg Case Rep 2019; 65:296-300. [PMID: 31759302 PMCID: PMC6880118 DOI: 10.1016/j.ijscr.2019.10.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/08/2022] Open
Abstract
Hydatid bone disease is caused by the Echinococcus granulosus worm. Osseous involvement accounts for 0.5% to 4% of cases in humans. No reports of hydatid disease in the entire humerus have been found in the bibliography. There is no consensus as regards the medical treatment of hydatidosis in the humerus. The affections of the entire humerus and the recurrences present a challenge of treatment for the reconstruction and rescue of the limb. We report a case of salvatage limb with a total humerus endophrostesis with 2 years of follow up.
Introduction Hydatid bone disease is caused by the Echinococcus granulosus worm. The location of the disease in the humerus is infrequent. No reports of hydatid disease in the entire humerus have been found in the bibliography. We present one case of primary hydatid bone disease affecting the entire humerus, which was treated with radical resection and total endoprosthesis of the humerus. Case A 24-year-old patient presented with a diaphyseal humerus fracture. The x-rays and MRI showed an oblique fracture and heterogeneous osteolytic and multiloculated images along the entire humerus. The biopsy resulted in hydatid cysts. Oncological resection of the humerus and total replacement of the same with a non-conventional prosthesis designed for the patient was performed. Conclusion Total humerus hydatidosis is infrequent, and there is scarce information about its treatment. The local resection plus graft and osteosynthesis conserving the bone has shown complications and recurrences. For healing, a radical procedure is necessary. Although functional results may be limited.
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Affiliation(s)
- Juan Martin Patino
- Departamento de Ortopedia y Traumatologia, Servicio de cirugía de mano y miembro superior, Hospital Militar Central "Cosme Argerich", Buenos Aires, Argentina.
| | - Alejandro José Ramos Vertiz
- Departamento de Ortopedia y Traumatologia, Servicio de cirugía de mano y miembro superior, Hospital Militar Central "Cosme Argerich", Buenos Aires, Argentina
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12
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Lenze U, Knebel C, Lenze F, Consalvo S, Lazic I, Breden S, Rechl H, von Eisenhart-Rothe R. [Total endoprosthetic replacement of femur, humerus and tibia]. DER ORTHOPADE 2019; 48:555-562. [PMID: 31190111 DOI: 10.1007/s00132-019-03762-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Improvements in diagnostics and effectiveness of chemotherapy have resulted in most patients with primary malignant bone tumours being candidates for limb salvage surgery. Herewith, the use of modern modular tumour endoprostheses allows for the replacement of all big joints and even entire long bones such as the femur, humerus and tibia. In this article, we focus on individual prerequisites for and challenges with performing a total endoprosthetic reconstruction of the above-mentioned anatomic structures. Additionally, data from the literature with regards to functional outcome, problems and complications are presented.
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Affiliation(s)
- U Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland.
| | - C Knebel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - F Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - S Consalvo
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - I Lazic
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - S Breden
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - H Rechl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
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Prabowo Y, Reksoprodjo AY. Modified total humeral replacement on unusual osteosarcoma of the humerus: A case report. Int J Surg Case Rep 2019; 58:132-137. [PMID: 31039510 PMCID: PMC6488563 DOI: 10.1016/j.ijscr.2019.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
The patient underwent a neoadjuvant chemotherapy before surgery, but the mass became more expanded. Limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was done. Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.
Introduction Osteosarcoma of the humerus is an unusual case. In order to salvage the limb, resection followed with total humeral replacement is preferred. In situations where those prostheses are not available, a technique of modified total humeral replacement could be used. Case presentation A 20-year-old female patient came with osteosarcoma of the right humerus accompanied by pathological humeral shaft fracture, with the onset of six months. The lesion extended along the proximal to distal part of humerus. The patient underwent a neoadjuvant chemotherapy before surgery and a limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was performed. Modifications to the shoulder hemiarthoplasty and total elbow prostheses were made, so both prostheses could join as one unit. Discussion After the surgery, no disturbances of hand function were seen, and functional outcome was evaluated by using Musculoskeletal Tumour Society Score (MSTS) score with score of 83% (excellent). After 3 years of follow up, patient could work and resume daily activity with improved MSTS score. There were neither sign of tumor recurrence nor distant metastasis on follow up. Conclusion Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.
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Affiliation(s)
- Yogi Prabowo
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
| | - Adisa Yusuf Reksoprodjo
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
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Miwa S, Shirai T, Yamamoto N, Hayashi K, Takeuchi A, Tada K, Kajino Y, Higuchi T, Abe K, Aiba H, Taniguchi Y, Tsuchiya H. Risk factors for surgical site infection after malignant bone tumor resection and reconstruction. BMC Cancer 2019; 19:33. [PMID: 30621654 PMCID: PMC6325841 DOI: 10.1186/s12885-019-5270-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Use of an implant is one of the risk factors for surgical site infection (SSI) after malignant bone tumor resection. We developed a new technique of coating titanium implant surfaces with iodine to prevent infection. In this retrospective study, we investigated the risk factors for SSI after malignant bone tumor resection and to evaluate the efficacy of iodine-coated implants for preventing SSI. METHODS Data from 302 patients with malignant bone tumors who underwent malignant bone tumor resection and reconstruction were reviewed. Univariate analyses were performed, followed by multivariate analysis to identify risk factors for SSI based on the treatment and clinical characteristics. RESULTS The frequency of SSI was 10.9% (33/302 tumors). Pelvic bone tumor (OR: 4.8, 95% CI: 1.8-13.4) and an operative time ≥ 5 h (OR: 3.4, 95% CI: 1.2-9.6) were independent risk factors for SSI. An iodine-coated implant significantly decreased the risk of SSI (OR: 0.3, 95% CI: 0.1-0.9). CONCLUSION The present data indicate that pelvic bone tumor and long operative time are risk factors for SSI after malignant bone tumor resection and reconstruction, and that iodine coating may be a promising technique for preventing SSI.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Toshiharu Shirai
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan. .,Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Kensaku Abe
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, 920-8641, Japan
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Landau MJ, Badash I, Yin C, Alluri RK, Patel KM. Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications. J Surg Oncol 2018. [PMID: 29513891 DOI: 10.1002/jso.25032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascularized bone grafting after tumor resection can be an important component in the treatment of bony neoplasms of the upper extremity. The purpose of this study was to determine the outcomes of free vascularized fibula grafting (FVFG) in the treatment of upper extremity sarcomas. METHODS A systematic review of the literature of FVFG used in the treatment of upper extremity sarcomas was performed. RESULTS A total of 56 studies were included in final analysis. The most common diagnosis was osteosarcoma (35.1%) and the most common recipient site was the humerus (57.3%). FVFG had a median union rate of 93.3%, with the median time to union being 5.0 months. The most common complications were fracture (11.7%), nerve injury (7.5%), infection (5.7%), and hammer toe deformity (3.3%). The reoperation rate was 34.5%. The most commonly reported standardized assessment of clinical outcomes following treatment was the Musculoskeletal Tumor Society Score, which had a median of 80% postoperatively. CONCLUSIONS FVFG in the treatment of malignant bony neoplasms of the upper extremity has a high rate of union and good overall outcomes; however, postoperative complication rates are high. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.
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Affiliation(s)
- Mark J Landau
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Christine Yin
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
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Surgery for bone sarcoma of the upper extremity. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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