Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Gulia, Ashish; Pruthi, Manish; Gupta, Srinath; Nadkarni, Shravan

doi:10.1016/j.jcot.2021.101496

Cited by 4 publications

(18 citation statements)

References 24 publications

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“…Distal humerus and proximal ulna are rare sites for primary and metastatic bone tumours. [1][2][3][4][5] However, the advent of neoadjuvant chemotherapy and sophisticated imaging techniques have made limb salvage feasible in many patients. [1][2][3][4][6][7][8][9][10][11][12][13] Reconstruction after tumour resection, however, has always been difficult, as a functional elbow demands both stability and an adequate range of motion (ROM).…”

Section: Introductionmentioning

confidence: 99%

“…Various methods of reconstruction have been reported, including elbow arthrodesis, 14 osteoarticular allograft, [15][16][17] vascularized fibular autograft, 6,18 osteochondral irradiated graft with/without fibula autograft, 9,13 radial neck to humeral trochlea, 19,20 allograft-prosthetic composite (APC), 1,11,12 and megaprosthesis. [1][2][3]5,7,8,[10][11][12]21,22 Arthrodesis is rarely used due to technical difficulties and poor function. Osteoarticular allograft could achieve a good functional outcome, but a wide range of complications have been reported including nonunion, instability, fracture, infection, and degenerative arthritis.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17] Although autograft reconstruction has a relatively lower risk of complications than allograft, this has only been reported anecdotally. 5,6,9,[18][19][20] Prosthetic arthroplasty, either APC or megaprosthesis, has been the main method due to the advantages of immediate stability, early mobilization, and satisfactory functional status. [1][2][3]5,7,8,[10][11][12]21,22 Nevertheless, elbow prostheses for oncological situations are mostly hinged articulation with the stem being inserted into the humeral and ulnar canals respectively, which produces high stress at the bushing and around the stem that can lead to mechanical complications.…”

Section: Introductionmentioning

confidence: 99%

“…5,6,9,[18][19][20] Prosthetic arthroplasty, either APC or megaprosthesis, has been the main method due to the advantages of immediate stability, early mobilization, and satisfactory functional status. [1][2][3]5,7,8,[10][11][12]21,22 Nevertheless, elbow prostheses for oncological situations are mostly hinged articulation with the stem being inserted into the humeral and ulnar canals respectively, which produces high stress at the bushing and around the stem that can lead to mechanical complications. [1][2][3]5,7,8,[10][11][12]21,22 Given that the high strain status was inevitable for total elbow arthroplasty (TEA), we considered the concept of hemiarthroplasty, which might afford a shorter operating time, wider ROM, and lower risks of wearing and loosening.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3]5,7,8,[10][11][12]21,22 Nevertheless, elbow prostheses for oncological situations are mostly hinged articulation with the stem being inserted into the humeral and ulnar canals respectively, which produces high stress at the bushing and around the stem that can lead to mechanical complications. [1][2][3]5,7,8,[10][11][12]21,22 Given that the high strain status was inevitable for total elbow arthroplasty (TEA), we considered the concept of hemiarthroplasty, which might afford a shorter operating time, wider ROM, and lower risks of wearing and loosening. 23,24 Distal humeral hemiarthroplasty (DHH) has been sporadically used for traumatic or inflammatory arthritis and tumour reconstruction in the past, but high rates of complications and unsatisfactory functional status have been reported.…”

Section: Introductionmentioning

confidence: 99%

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

Liang

Yang

Guo

et al. 2022

The Bone & Joint Journal

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Liang

Yang

Guo

et al. 2022

The Bone & Joint Journal

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Outcomes of management of primary benign aggressive or malignant bone tumors around the elbow by limb‐salvage surgery

Ebeid,

Badr,

Mesregah

et al. 2023

J. exp. orthop.

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Purpose Bone tumors around the elbow are rare, with frequently delayed diagnosis. The current study aimed to assess the functional and oncological outcomes of limb salvage surgery for primary benign aggressive or malignant bone tumors around the elbow. Methods We conducted a retrospective review of patients with primary aggressive benign and malignant bone tumors around the elbow treated with limb salvage surgery between 1995 and 2020 at a single musculoskeletal oncology center. The minimum follow-up period was 24 months. Functional results were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the last follow‐up visit. Local recurrence, chest metastasis, and complications were recorded. Results This study included 30 patients, 19 males and 11 females, with a mean age of 25.4 ± 14.2 years. The tumor location was the distal humerus (n = 21), proximal radius (n = 5), and proximal ulna (n = 4). Reconstruction was done by elbow fusion using fibular graft (n = 10), mobile endoprosthesis (n = 9), excision arthroplasty (n = 7), and extracorporeal freezing and reimplantation (n = 4). The mean follow-up period was 36.2 ± 21.3 months. The median follow-up MSTS score was 27 [Interquartile range (IQR): 26–30]. Skeletally immature patients had a significantly higher MSTS score. The rate of postoperative complications was 26.7%. Conclusion Limb salvage surgery with different reconstructive options for benign aggressive and malignant bone tumors around the elbow can achieve good functional and oncological outcomes. Level of evidence Level IV.

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Elbow hemiarthroplasty with a 3D-printed prosthesis for distal humeral bone defects after tumor excision: a case report

et al. 2023

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Introduction The distal humerus is a rare site for primary and metastatic bone tumors. Due to the scarcity of cases and lack of standardized surgical strategies, it is often difficult for surgeons to choose the right choice. The application of a 3D-printed prosthesis with hemiarthroplasty for the treatment of the distal humerus after tumor resection can be a very effective option. Case presentation We present a clinical case of a 3D-printed distal humeral prosthesis for the treatment of bone defects caused by metastatic bone tumors. The preoperative evaluation was aggressively performed, and the decision was made to distal humeral hemiarthroplasty (DHH) after wide resection of the tumor segment bone. Processing of the Digital Imaging and Communications in Medicine (DICOM) data from CT scans performed after mirror conversion using CT data of the contralateral humerus, we designed a 3D-printed distal humeral prosthesis with hemiarthroplasty. After reconstruction of bone and surrounding soft tissue by the 3D-printed prosthesis combined with the LARS ligament and regular follow-up for 12 months, the patient had an MSTS-93 score of 29 and an MEP of 100, which reached a good level, and the patient was fully competent in normal daily activities. Conclusions Our results show that the 3D-printed modular prosthesis with hemiarthroplasty is a very effective option for cases of large elbow bone defects due to primary bone tumors or metastatic disease. However, careful preoperative preparation is required for the best outcome. Careful preoperative preparation and long-term follow-up are essential for the best outcome.

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Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Cited by 4 publications

References 24 publications

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

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

Outcomes of management of primary benign aggressive or malignant bone tumors around the elbow by limb‐salvage surgery

Elbow hemiarthroplasty with a 3D-printed prosthesis for distal humeral bone defects after tumor excision: a case report

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