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A bioceramic endoprosthesis for the replacement of the proximal humerus

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Summary

In patients with malignant tumors in the region of the shoulder, radical resection can avoid amputation in most instances. To improve the function of the arm, endoprosthetic replacement of the defect is desirable.

A three-component endoprosthesis made of a bioceramic material (aluminium oxide) was designed, implanted without bone cement. Fast anchorage to bone is achieved by using a conical sleeve, fixed upon the previously conically reamed humerus shaft. A stable primary fit is always feasible. Subsequent bone in-growth into grooves inside the conical sleeve provides a permanent anchorage of the endoprosthesis.

The authors experiences are based on implantations of 38 endoprostheses. The original diseases were primary malignant bone tumors in 19 patients, one case of “solitary” plasmocytoma and metastases into the proximal humerus in 16 patients. In two women, resection was made because of posttraumatic subcapital humeral pseudarthrosis.

The follow-up study includes only those 27 cases operated on at least one year ago. 12 of the 14 patients with primary tumors have been surviving for 12–55 months (range 27.4) without signs of metastases or recurrent disease. Seven patients with metastases died of their original diseases after 7.7 months on the average.

Owing to extensive resection of the shoulder musculature the mobility in the shoulder joint is considerably reduced.

All the patients have good movement of the elbow joint and free function of the hand.

Zusammenfassung

Bei Patienten mit malignen Tumoren in der Schulterregion kann durch radikale Resektion eine Amputation fast immer umgangen werden. Zur Funktionsverbesserung des operierten Arms ist die Implantation einer Endoprothese wünschenswert.

Es wurde eine 3teilige Endoprothese aus einem biokeramischen Material (Aluminiumoxid) entwickelt, die ohne Knochenzement implantiert wird. Eine feste Verankerung im Knochen wird durch Verwendung einer konischen Hülse, die auf dem vorher konisch zugearbeiteten Oberarmschaft befestigt wird, ermöglicht. Ein stabiler Primärsitz ist immer möglich. Das späatere Einwachsen in Rillen innerhalb der konischen Hülse verankert die Endoprothese dauerhaft.

Die Autoren haben bisher in 38 Fällen Endoprothesen implantiert. Als Grunderkrankung fanden sich primär maligne Knochentumoren bei 19 Patienten, 1 Patient mit „solitärem” Plasmozytom und Metastasen im proximalen Humerus bei 16 Patienten. Bei 2 Frauen erfolgte die Operation wegen posttraumatischer, subkapitaler Humeruspseudarthrose.

Die Nachuntersuchungsstudie enthält nur jene 27 Fälle, bei denen der Beobachtungszeitraum mindestens 1 Jahr beträgt. 12 der 14 Patienten mit primär malignen Knochentumoren iiberleben derzeit zwischen 12 und 55 Monaten (durchschnittlich 27,4 Monate) ohne Anzeichen von Metastasen oder Lokalrezidiven. 7 Patienten mit Metastasen starben nach durchschnittlich 7,7 Monaten an ihrer Grunderkrankung.

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Authors and Affiliations

  1. Orthopaedic Department of the Hospital Vienna-Gersthof, Wielemansgasse 28, A-1180, Vienne, Austria

    M. Salzer & K. Knahr

  2. Rosenthal-Technik AG, Luitpoldstr. 15, D-8560, Lauf/Pegnitz, Germany

    H. Locke & N. Stärk

  3. 1st Orthopaedic University Clinic, Na Bojisti 1, 12000, Prague, Czechoslovakia

    Z. Matejovsky

  4. Bone Res. Lab., Histolog.-Embryolog. Inst. of the University of Vienna, Schwarzspanierstraße 17, A-1090, Vienna, Austria

    H. Plenk Jr.

  5. Dept. of Surgery, Veterinary University of Vienna, Linke Bahngasse 11, A-1030, Vienna, Austria

    G. Punzet

  6. Orthopaedic University Clinic, Garnisongasse 13, A-1090, Vienna, Austria

    K. Zweymüller

Authors
  1. M. Salzer
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  2. K. Knahr
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  3. H. Locke
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  4. N. Stärk
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  5. Z. Matejovsky
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  6. H. Plenk Jr.
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  7. G. Punzet
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  8. K. Zweymüller
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Salzer, M., Knahr, K., Locke, H. et al. A bioceramic endoprosthesis for the replacement of the proximal humerus. Arch. Orth. Traum. Surg. 93, 169–184 (1979). https://doi.org/10.1007/BF00523668

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  • DOI: https://doi.org/10.1007/BF00523668

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