Elbow hemiarthroplasty with a 3D-printed megaprosthesis for defects of the distal humerus or proximal ulna after tumour resection

Abstract

Aims The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection. Methods From June 2018 to January 2020, 13 patients with aggressive or malignant tumours involving the distal humerus (n = 8) or proximal ulna (n = 5) were treated by en bloc resection and reconstruction with a 3D-printed megaprosthesis with hemiarthroplasty, designed in our centre. In this paper, we summarize the baseline and operative data, oncological outcome, complication profiles, and functional status of these patients. Results Preparation of the prosthesis was a mean of 8.0 days (SD 1.5), during which time no patients experienced tumour progression. The mean operating time and intraoperative blood loss were 158.1 minutes (SD 67.6) and 176.9 ml (SD 187.8), respectively. All of the prostheses were implanted successfully. During a mean follow-up of 25.7 months (SD 7.8), no patients died, but four had complications (two superficial wound problems, one temporary palsy of radial nerve, and one dislocation). No aseptic loosening, structural failure, infection, heterotopic ossification, or degenerative arthritis was seen in this study. The mean flexion of the elbow was 119.6° (SD 15.9°) and the mean extension lag was 11.9° (SD 13.8°). The mean Musculoskeletal Tumor Society 93 score and Mayo Elbow Performance Score were 28.4 (SD 0.9) and 97.7 (SD 4.4), respectively. Conclusion The custom-made, 3D-printed megaprosthesis with hemiarthroplasty is a feasible option for functional reconstruction after resection of a tumour in the distal humerus or proximal ulna. Cite this article: Bone Joint J 2022;104-B(6):747–757.

Elbow hemiarthroplasty with a 3D-printed megaprosthesis for distal humeral bone defects after tumor excision: A cases report

“…With such delicate soft tissue reconstruction, the stability of the normal elbow joint can be approached. On the contrary, suturing soft tissue directly into smooth holes does not provide enough immediate stability and is prone to suture tearing, sloughing leading to subluxation during early postoperative exercise [5]. In our case, the LARS ligament wrapping prosthesis as a whole before suturing the soft tissue structures to this whole allows for a more satisfactory immediate xation, which is conducive to early functional exercise and reduces the risk of early instability.…”

“…The indications for performing a distal humeral replacement are broad, ranging from bone and soft tissue sarcomas, bone metastases, multiple myeloma, and benign bone tumors to patients with posttraumatic bone defects or failed previous joint replacement [11,12]. Megaprosthesis and allograft-prosthetic composite (APC) has been the mainstay of reconstruction for the treatment of distal humeral and proximal ulnar defects, but the concept of hemiarthroplasty has rarely been adopted and its use in oncologic cases has been reported in only small case series [5,13]. Elbow surgery is associated with a greater likelihood of developing major complications after trauma, such as severe elbow degeneration, complete elbow joint stiff, elbow adhesion, distal humeral delayed union or nonunion and bone defects [12].…”

What’s New in Musculoskeletal Tumor Surgery

“…Liang 32 (2022) Elbow Hemiarthroplasty with a 3D-Printed Megaprosthesis for Defects of the Distal Humerus or Proximal Ulna After Tumour Resection: A Preliminary Report There were 13 patients with aggressive or malignant tumors of the distal humerus or proximal ulna who underwent en bloc resection and reconstruction with a 3D-printed megaprosthesis with hemiarthroplasty. The preparation of the prosthesis took a mean of 8.0 days.…”

“…However, only 13 patients were still alive for the functional outcome assessment. Liang et al 32 and Kruckeberg et al 34 reviewed the outcomes of patients who underwent elbow The authors prospectively recruited 54 patients who were diagnosed with osteosarcoma or Ewing sarcoma. The presence of skeletal metastases was assessed with 18 F-FDG PET/CT, whole-body MRI, and 99m Tc-MDP skeletal scintigraphy.…”

“…However, only 13 patients were still alive for the functional outcome assessment. Liang et al 32 and Kruckeberg et al 34 reviewed the outcomes of patients who underwent elbow arthroplasty with custom-made or standard prostheses and reported that, despite a high risk of complications, implant survival at 2 and 5 years was 88% to 100%, with excellent functional outcomes. With regard to the proximal humerus, Houdek et al reviewed 11 patients with a failed previous proximal humeral reconstruction who were treated with reverse shoulder arthroplasty with an allograft-prosthetic composite.…”