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Does Total Humeral Endoprosthetic Replacement Provide Reliable Reconstruction With Preservation of a Useful Extremity?

  • Symposium: 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Controversy exists regarding the ideal method of reconstruction after proximal humeral resection and several reconstructive techniques have been reported. The reconstructive options are very limited when resection of the entire humerus is required. One option is endoprosthetic reconstruction, but there have been few published studies on the outcome of total humeral endoprosthetic reconstruction.

Questions/purposes

The purposes of this study were (1) to assess the longevity of total humerus prostheses in those patients who survived their disease; (2) to review the complications associated with this prosthesis; and (3) to assess the Musculoskeletal Tumor Society functional score in survivors.

Methods

Thirty-four patients (10 males, 24 females) with a mean age of 26 years (range, 7–86 years) were included in this study. Histological diagnosis was osteosarcoma in 15 patients, chondrosarcoma in seven, Ewing’s sarcoma in seven, metastatic carcinoma in three, liposarcoma in one, and giant cell tumor of bone in one remaining patient. Twenty-nine patients had their total humeral endoprosthetic replacement for primary reconstruction, whereas the remaining five patients received their implants for failures with other reconstructive techniques. At a minimum followup of 3 months (mean, 8.2 years; range, 3 months to 29 years), 16 patients were alive with no evidence of disease, whereas 13 of the remaining 18 died with metastatic disease. Local recurrence was seen in five patients and all eventually died of disease progression.

Results

According to the Kaplan-Meier survival analysis, the cumulative 10-year implant survival rate was 90%. Periprosthetic infection was seen in four patients, postoperative radial nerve palsy in one, and proximal migration of the prosthesis in three, whereas three patients needed a change of the articular elbow bushings at a mean of 16 years after the implant insertion. The mean Musculoskeletal Tumor Society functional score of the 28 patients who survived their disease for more than 12 months after the index procedure and could therefore be functionally assessed was 83% (range, 60%–93%).

Conclusions

From this small, preliminary report, we suggest that total humeral endoprosthetic replacement may be a reasonable option of reconstruction after tumor resection. We have shown that this prosthesis preserves the function of the hand. The local recurrence rate observed suggests that careful selection of patients is crucial. Infection was our most common surgical complication, but we showed that in those who survived their tumor, this prosthesis offers a method to preserve a functional upper extremity in some patients. Further study with more patients is necessary to confirm the value of this reconstruction method.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP, UK

    Hazem Wafa FRCSEd(Tr & Orth), Krishna Reddy FRCSEd(Tr & Orth), Robert Grimer DSc, Adesegun Abudu FRCS(Tr & Orth), Lee Jeys FRCS(Tr & Orth), Simon Carter FRCS & Roger Tillman FRCS(Tr & Orth)

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  1. Hazem Wafa FRCSEd(Tr & Orth)
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  2. Krishna Reddy FRCSEd(Tr & Orth)
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  3. Robert Grimer DSc
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  4. Adesegun Abudu FRCS(Tr & Orth)
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  5. Lee Jeys FRCS(Tr & Orth)
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  6. Simon Carter FRCS
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  7. Roger Tillman FRCS(Tr & Orth)
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Corresponding author

Correspondence to Hazem Wafa FRCSEd(Tr & Orth).

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Wafa, H., Reddy, K., Grimer, R. et al. Does Total Humeral Endoprosthetic Replacement Provide Reliable Reconstruction With Preservation of a Useful Extremity?. Clin Orthop Relat Res 473, 917–925 (2015). https://doi.org/10.1007/s11999-014-3635-5

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  • DOI: https://doi.org/10.1007/s11999-014-3635-5

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