Custom-made endoprosthetic total humerus reconstruction for musculoskeletal tumours

Abstract

Purpose We analysed 11 patients with malignant musculoskeletal tumours of the humerus who underwent limb salvage surgery with total humeral custom endoprosthesis from 1990 to 2009. Methods There were six male and five female patients, with a mean age of 17 years. The most common diagnosis was osteosarcoma. The average follow-up period was 66 months, with the maximum being 180 months. Functional and oncological outcomes were analysed. Results The one and five year cumulative survival (Kaplan-Meier method) rates were 90.9% and 77.9 %. The average Musculoskeletal Tumour Society Score (MSTS) was 80%. Two patients died due to metastasis. One patient had a forequarter amputation for local recurrence. The procedure provides fast recovery and relatively good restoration of elbow function, whereas active shoulder movements remain limited Conclusion Total humeral custom endoprosthetic replacement represents a viable treatment option in indicated patients, providing reliable and reasonable function of the upper limb, with a low complication rate.

The results of total humeral replacement following excision for primary bone tumour

“…Our experience has been similar to that of other authors who have performed a forequarter amputation for local recurrence after THER. 5,6 The mean MTSS functional score of 73% in our study is encouraging when compared with other series. 6,21,22 Patients reported good psychological acceptance after limb salvage with the THER despite having compromised shoulder function.…”

“…23 We were fortunate not to have any nerve palsy or infection in our patients, although they have been found in other series. 5,6,22 The absence of radiotherapy in our patients may have contributed to avoiding infection. 21 Local recurrence is a reflection of adequacy of oncological clearance and the effectiveness of chemotherapy.…”

“…4,6,21,22 Most series comprise a variety of aetiologies including primary malignant tumours, benign lesions, metastatic disease, degenerative disease and failed joint replacements. 4,5,21,22 Our study documents the largest series of THER for primary bone sarcomas. Proximal migration is commonly reported with proximal humeral and total humeral replacements.…”

“…Proximal migration is commonly reported with proximal humeral and total humeral replacements. 4,5 Our use of an inexpensive polypropylene mesh to reinforce the capsule has helped avoid this. Some authors have used a more expensive mesh commonly used in cardiovascular procedures for a similar purpose.…”

“…[4][5][6] We present our experience of these implants after resection of primary malignant bone tumours. The oncological and functional outcome, and the complications and implant survival are presented.…”