Endoprosthetic replacement of the proximal humerus

Abstract

e studied 100 patients who had undergone endoprosthetic replacement of the proximal humerus between 1976 and 1998. The outcome was assessed with regard to the survivorship of the patients, the salvaged limbs and the prostheses. Function was determined in the 47 surviving patients, of whom 30 were assessed using the Musculo-Skeletal Tumour Society (MSTS) rating scale and 38 completed the Toronto Extremity Salvage Score (TESS) questionnaire. The median age of the patients was 34 years (10 to 80). The mean follow-up period for surviving patients was nine years (2 to 20). The mean MSTS score at follow-up was 79% and the mean TESS score was 72%. The length of bone which was resected influenced the functional outcome. Abduction of the shoulder was to 45˚ in most patients. The overall survival was 42% at ten years and that of the limb without amputation 93%. The survival of the prostheses using mechanical failure as the endpoint was 86.5% at 20 years. Endoprosthetic replacement of the proximal humerus is a predictable procedure providing reasonable function of the arm with a low rate of complications at long-term follow-up.

Segmental Resection and Replantation Have a Role for Selected Advanced Sarcomas in the Upper Limb

“…The artificial ligament provided restraint for passive motion on axial, longitudinal (compression and elongation of the limb), and translational planes. Our patients' overall functional score was 20 at the last followup according to the functional rating system of the Musculoskeletal Tumor Society, which is comparable to the functional scores of 16 to 23.7 after other limb-salvage procedures such as allografts [9] and endoprostheses [17,20]. The functional score of the patients probably is correlated with ROM of the shoulder, length of the shortened arm, and power of the pinch and grasp because the total Musculoskeletal Tumor Society score is determined by adding the scores for pain, emotional acceptance, hand positioning, manual dexterity, and lifting ability.…”

“…Various techniques for reconstructing bony and soft tissue defects after tumor resection with wide or radical margins have been described, including the use of autologous vascularized bone graft [14,19], allograft [8,9], an endoprosthesis [2,13,16,17,20], or an allograft-prosthesis composite [3]. However, amputation has been advocated for selective cases of primary sarcoma of the upper extremity when they are large or extensive or when they have neurovascular involvement, local tumor contamination after unplanned surgery, or pathologic fracture [10,18,21] of Stage IIB or III [7].…”

Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

“…In fact, active motion at the shoulder is generally quite poor after oncologic resection and endoprosthetic replacement. 19 In the current series, the reconstructive techniques were varied, and there was quite a large range of functional deficits (data not shown). Although a few patients had excellent function (Fig.…”

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

“…Currently, it is not possible to avoid periprosthetic infection completely, despite the use of systemic antibiotic treatment, operating rooms with laminar airflow, and routine screening for methicillin-resistant Staphylococcus aureus (MRSA). In the literature, overall infection rates of between 8.7% and 14% have been reported, with lower rates in the upper extremity and higher rates in the lower extremity [2,7,[16][17][18][19]. Patients with proximal tibia replacements in particular are at high risk for periprosthetic infection.…”