Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh
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The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction.
We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device.
We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13–43 months).
There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43° (range, 15°–170°) and mean shoulder abduction of 38 (range, 15°–110°). The mean operative time was 121 minutes (range, 80–170 minutes) and the mean blood loss was 220 mL (range, 50–750 mL). One patient had a superficial wound infection and none a deep infection requiring removal of the graft or prosthesis.
The data suggest the use of a synthetic vascular mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment and reconstruction after tumor resection.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Amadi HO, Hansen UN, Bull AM. A numerical tool for the reconstruction of the physiological kinematics of the glenohumeral joint. Proc Inst Mech Eng H. 2009;223:833–837. CrossRef
- Amin SN, Ebeid WA. Shoulder reconstruction after tumor resection by pedicled scapular crest graft. Clin Orthop Relat Res. 2002;397:133–142. CrossRef
- Bacci G, Ferrari S, Lari S, Mercuri M, Donati D, Longhi A, Forni C, Bertoni F, Versari M, Pignotti E. Osteosarcoma of the limb. Amputation or limb salvage in patients treated by neoadjuvant chemotherapy. J Bone Joint Surg Br. 2002;84:88–92. CrossRef
- Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Meller I, Malawer MM. Limb-sparing resections of the shoulder girdle. J Am Coll Surg. 2002;194:422–435. CrossRef
- Bos G, Sim F, Pritchard D, Shives T, Rock M, Askew L, Chao E. Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res. 1987;224:178–191.
- Bruck JC, Weber U. Tumor-related arthrodesis. Reconstruction of the shoulder contour using a free TRAM (Transverse Rectus Abdominis Musculocutaneous) flap [in German]. Orthopade. 1998;27:441–444. CrossRef
- Camnasio F, Scotti C, Peretti GM, Fontana F, Fraschini G. Prosthetic joint replacement for long bone metastases: analysis of 154 cases. Arch Orthop Trauma Surg. 2008;128:787–793. CrossRef
- Cheng EY, Gebhardt MC. Allograft reconstructions of the shoulder after bone tumor resections. Orthop Clin North Am. 1991;22:37–48.
- Dal Monte A, Manes E. Osteosarcoma of the proximal femur and humerus in children treated by resection, endoprosthesis and complementary chemotherapy. Ital J Orthop Traumatol. 1983;9:151–156.
- Deutsch M, Meinhart J, Zilla P, Howanietz N, Gorlitzer M, Froeschl A, Stuempflen A, Bezuidenhout D, Grabenwoeger M. Long-term experience in autologous in vitro endothelialization of infrainguinal ePTFE grafts. J Vasc Surg. 2009;49:352–362; discussion 362. CrossRef
- De Wilde LF, Plasschaert FS, Audenaert EA, Verdonk RC. Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery. Clin Orthop Relat Res. 2005;430:156-162. CrossRef
- Doble M, Makadia N, Pavithran S, Kumar RS. Analysis of explanted ePTFE cardiovascular grafts (modified BT shunt). Biomed Mater. 2008;3:034118. CrossRef
- Eggers IM, Mennen U. The EFFUL (Evaluation of Function in the Flail Upper Limb) system. A ranking score system to measure improvement achieved by surgical reconstruction and rehabilitation. J Hand Surg Br. 1997;22:388–394. CrossRef
- Fernie GR, Kostuik JP, Lobb RJ. A percutaneous implant using a porous metal surface coating for adhesion to bone and a velour covering for soft tissue attachment: results of trials in pigs. J Biomed Mater Res. 1977;11:883–891. CrossRef
- Francis KC, Marchetti PG, Caruso M. Inter-scapulo-thoracic resection (Tikhoff-Linberg Operation) [in Italian]. Arch Putti Chir Organi Mov. 1964;19:331–340.
- Freels DB, Kilpatrick S, Gordon ES, Ward WG. Animal model for evaluation of soft tissue ingrowth into various types of porous coating. Clin Orthop Relat Res. 2002;397:315–322. CrossRef
- Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res. 2001;393:264–271. CrossRef
- Greisler HP, Tattersall CW, Henderson SC, Cabusao EA, Garfield JD, Kim DU. Polypropylene small-diameter vascular grafts. J Biomed Mater Res. 1992;26:1383–1394. CrossRef
- Heitmann C, Erdmann D, Levin LS. Treatment of segmental defects of the humerus with an osteoseptocutaneous fibular transplant. J Bone Joint Surg Am. 2002;84:2216–2223.
- Higuera CA, Inoue N, Lim JS, Zhang R, Dimaano N, Frassica FJ, Chao EY. Tendon reattachment to a metallic implant using an allogenic bone plate augmented with rhOP-1 vs. autogenous cancellous bone and marrow in a canine model. J Orthop Res. 2005;23:1091–1099. CrossRef
- Huffman GR, Tibone JE, McGarry MH, Phipps BM, Lee YS, Lee TQ. Path of glenohumeral articulation throughout the rotational range of motion in a thrower’s shoulder model. Am J Sports Med. 2006;34:1662–1669. CrossRef
- Kassab M, Dumaine V, Babinet A, Ouaknine M, Tomeno B, Anract P. [Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:15–23.
- Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26:764–772.
- Kiss J, Sztrinkai G, Antal I, Szendroi M. Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elbow Surg. 2007;16:273–279. CrossRef
- Kitagawa Y, Thai DM, Choong PF. Reconstructions of the shoulder following tumour resection. J Orthop Surg (Hong Kong). 2007;15:201–206.
- Kumar VP, Satku SK, Mitra AK, Pho RW. Function following limb salvage for primary tumors of the shoulder girdle. 10 patients followed 4 (1–11) years. Acta Orthop Scand. 1994;65:55–61.
- LaBerge M, Bobyn JD, Rivard CH, Drouin G, Duval P. Study of soft tissue ingrowth into canine porous coated femoral implants designed for osteosarcomas management. J Biomed Mater Res. 1990;24:959–971. CrossRef
- Lukin AV, Kiss EE, Grishkin VA, Chernova VI. Individual endoprosthesis in a malignant tumor of the humerus [in Russian]. Vestn Khir Im I I Grek. 1987;139:65–66.
- Malawer M. Surgical technique and results of limb sparing surgery for high grade bone sarcomas of the knee and shoulder. Orthopedics. 1985;8:597–607.
- Malawer MM. Tumors of the shoulder girdle. Technique of resection and description of a surgical classification. Orthop Clin North Am. 1991;22:7–35.
- Malawer MM, Sugarbaker PH, Lampert M, Baker AR, Gerber NL. The Tikhoff-Linberg procedure: report of ten patients and presentation of a modified technique for tumors of the proximal humerus. Surgery. 1985;97:518–528.
- Marcove RC, Lewis MM, Huvos AG. En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Relat Res. 1977;124:219–228.
- Mazurkiewicz T, Warda E, Kopacz J, Mazurkiewicz M. Results of the megaprosthesis replacement reconstruction proximal femoral resection bone tumors. Ortop Traumatol Rehabil. 2005;7:595–599.
- Moran M, Stalley PD. Reconstruction of the proximal humerus with a composite of extracorporeally irradiated bone and endoprosthesis following excision of high grade primary bone sarcomas. Arch Orthop Trauma Surg. 2009;129:1339–1345. CrossRef
- Mourikis A, Mankin HJ, Hornicek FJ, Raskin KA. Treatment of proximal humeral chondrosarcoma with resection and allograft. J Shoulder Elbow Surg. 2007;16:519–524. CrossRef
- Neer CS, 2nd. Prosthetic Replacement of the Humeral Head: Indications and Operative Technique. Surg Clin North Am. 1963;43:1581–1597.
- O’Connor MI, Sim FH, Chao EY. Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am. 1996;78:1872–1888.
- Ochiai Y, Imoto Y, Sakamoto M, Kajiwara T, Sese A, Watanabe M, Ohno T, Joo K. Mid-term follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure. Eur J Cardiothorac Surg. 2009;36:63–67; discussion 67–68. CrossRef
- Petrovic P, Lotina S, Djordjevic M, Avramov S, Pfau J, Velimirovic D, Fabri M, Stojanov P, Savic D. Results of 132 PTFE (Gore-Tex) bifurcated graft implantations. J Cardiovasc Surg (Torino). 1989;30:897–901.
- Picci P, Mercuri M, Ferrari S, Alberghini M, Briccoli A, Ferrari C, Pignotti E, Bacci G. Survival in high-grade osteosarcoma: improvement over 21 years at a single institution. Ann Oncol. 2009 Nov 4. [Epub ahead of print].
- Probyn LJ, Wunder JS, Bell RS, Griffin AM, Davis AM. A comparison of outcome of osteoarticular allograft reconstruction and shoulder arthrodesis following resection of primary tumours of the proximal humerus. Sarcoma. 1998;2:163–170. CrossRef
- Quill G, Gitelis S, Morton T, Piasecki P. Complications associated with limb salvage for extremity sarcomas and their management. Clin Orthop Relat Res. 1990;260:242–250.
- Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol. 2000;73:198–205. CrossRef
- Ross AC, Wilson JN, Scales JT. Endoprosthetic replacement of the proximal humerus. J Bone Joint Surg Br. 1987;69:656–661.
- Runne WC, van Sambeek KJ, Stierum JL, van Tongerloo RB. Femoral endoprosthesis fixation with a soft, flexible low modulus stem coating. Four to six year clinical results. Orthopedics. 1989;12:529–535.
- Sim IW, Tse LF, Ek ET, Powell GJ, Choong PF. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumours around the knee. Eur J Surg Oncol. 2007;33:796–802.
- Thai DM, Kitagawa Y, Choong PF. Outcome of surgical management of bony metastases to the humerus and shoulder girdle: a retrospective analysis of 93 patients. Int Semin Surg Oncol. 2006;3:5. CrossRef
- Toyoda Y, Shinohara N, Harabayashi T, Abe T, Akino T, Sazawa A, Nonomura K. Survival and prognostic classification of patients with metastatic renal cell carcinoma of bone. Eur Urol. 2007;52:163–168. CrossRef
- Verhagen HJ, Blankensteijn JD, de Groot PG, Heijnen-Snyder GJ, Pronk A, Vroom TM, Muller HJ, Nicolay K, van Vroonhoven TJ, Sixma JJ, Eikelboom BC. In vivo experiments with mesothelial cell seeded ePTFE vascular grafts. Eur J Vasc Endovasc Surg. 1998;15:489–496. CrossRef
- Wittig JC, Bickels J, Kellar-Graney KL, Kim FH, Malawer MM. Osteosarcoma of the proximal humerus: long-term results with limb-sparing surgery. Clin Orthop Relat Res. 2002;397:156–176. CrossRef
- Wodajo FM, Bickels J, Wittig J, Malawer M. Complex reconstruction in the management of extremity sarcomas. Curr Opin Oncol. 2003;15:304–312. CrossRef
- Yang Q, Li J, Yang Z, Li X, Li Z. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. Int Orthop. 2009 Aug 23. [Epub ahead of print].
- Yang X, Tare RS, Partridge KA, Roach HI, Clarke NM, Howdle SM, Shakesheff KM, Oreffo RO. Induction of human osteoprogenitor chemotaxis, proliferation, differentiation, and bone formation by osteoblast stimulating factor-1/pleiotrophin: osteoconductive biomimetic scaffolds for tissue engineering. J Bone Miner Res. 2003;18:47–57. CrossRef
- Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh
Clinical Orthopaedics and Related Research®
Volume 468, Issue 11 , pp 2896-2903
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- 1. Department of Orthopaedics and Sports Medicine, University of South Florida, 13220 USF Laurel Drive, MDF 5th floor, Mail Code MDC 106, Tampa, FL, 33613, USA
- 2. Sarcoma Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA