Allograft Reconstruction for the Treatment of Musculoskeletal Tumors of the Upper Extremity

Abstract

In comparison with the lower extremity, there is relatively paucity literature reporting survival and clinical results of allograft reconstructions after excision of a bone tumor of the upper extremity. We analyze the survival of allograft reconstructions in the upper extremity and analyze the final functional score according to anatomical site and type of reconstruction. A consecutive series of 70 allograft reconstruction in the upper limb with a mean followup of 5 years was analyzed, 38 osteoarticular allografts, 24 allograft-prosthetic composites, and 8 intercalary allografts. Kaplan-Meier survival analysis of the allografts was performed, with implant revision for any cause and amputation used as the end points. The function evaluation was performed using MSTS functional score. Sixteen patients (23%) had revision surgery for 5 factures, 2 infections, 5 allograft resorptions, and 2 local recurrences. Allograft survival at five years was 79% and 69% at ten years. In the group of patients treated with an osteoarticular allograft the articular surface survival was 90% at five years and 54% at ten years. The limb salvage rate was 98% at five and 10 years. We conclude that articular deterioration and fracture were the most frequent mode of failure in proximal humeral osteoarticular reconstructions and allograft resorption in elbow reconstructions. The best functional score was observed in the intercalary humeral allograft.

Endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus after tumor resection: Cost and benefits

“…Therefore, amputation of the shoulder girdle should be avoided if possible. 3 The increasing and often unpredictable longevity of patients with metastatic disease, 1,4 coupled with higherthan-expected failure rates after internal fixation with or without intralesional treatment and radiotherapy, 5,6 has led to renewed interest in more aggressive local control efforts through proximal humeral resection and reconstruction. 7 Reconstruction of the defects that result after resection of the proximal humerus could be performed by different comparable methods.…”

Proximal humerus allograft prosthetic composites: technique, outcomes, and pearls and pitfalls

“…The complication rate at 5 years was 25 % with 1 patient with local recurrence, 1 with infection, and 2 with non-unions. The MSTS functional score demonstrated comparable results with osteoarticular allografts, 25 and 23 points, respectively [19].…”

“…Aponte-Tinao et al [19] reported in 2013 their experience using osteoarticular allografts in different locations of the upper extremity. Twenty-one patients of these series had reconstructions of the proximal humerus.…”

“…Fractures occurred in 5 patients (24 %), and local recurrence was seen in 2. Allograft survival rates were reported as 79 % at 5 years and 69 % at 10 years [19].…”

“…Aponte-Tinao et al [19] reported results of allograft reconstruction of various locations in the upper extremity. Of the 70 consecutive patients, 16 were proximal humerus APC constructs.…”