A bioceramic endoprosthesis for the replacement of the proximal humerus

Abstract

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.

Advances in Segmental Endoprosthetic Reconstruction for Extremity Tumors: A Review of Contemporary Designs and Techniques

“…In these cases, soft-tissue reattachment is especially important to prevent future dislocations. 7,20,[48][49][50] Other materials and techniques are currently being investigated to improve soft-tissue integration. 16,[25][26][27][28]36,[38][39][40]67 In the proximal tibia, the gastrocnemius fl ap can be reinforced using various materials such as artifi cial acrylic meshes (eg, Lars, Trevira) or other biologically derived devices.…”

“…6 In these early reports, signifi cant diversity existed among the various devices utilized. In 1973, Parrish 5 reported his experience using homologous cadaveric allografts to reconstruct joint defects created by tumor excision, and in 1979, Salzer et al 7 described the use of a modular ceramic endoprosthesis for the replacement of the resected proximal humerus. In 1980, Katznelson and Nerubay 8 performed a total femoral reconstruction in 5 patients using a device that extended from the hip to insert directly into the proximal tibia without an articulating knee joint.…”

Proximal humeral replacement using a fixed-fulcrum endoprosthesis

“…It is our opinion that in this situation, where reduction is not performed, the dislocated endoprosthesis then acts like an unconstrained endoprosthesis. 6,[17][18][19] With the new constrained liner the risk of dislocation seems to have been eradicated, and hence functional results will improve further. The four cases in which the new constrained liner was used showed no dislocations and improved functional results.…”

New endoprosthesis suspension method with polypropylene monofilament knitted mesh after resection of bone tumors in proximal humerus

“…4 Since then, some authors reported some cases, and in the 1960s case series also appeared, but the indications for arthroplasty in early reports were dislocation fractures and rheumatoid arthritis. Applications of a massive endoprosthetic replacement, not only for the humeral head but also from proximal diaphysis to humeral head after resection of bone tumors, were reported by Salzer 24 in 1979 and Campanacci 5 in 1982. Although about 30 years have passed since the first report on endoprosthetic reconstruction, instability of the shoulder joint after it is still an unsolved problem.…”