Improvement of the shoulder function after large segment resection of the proximal humerus with the use of an inverse tumour prosthesis

Streitbuerger, Arne; Henrichs, Marcel-Philipp; Gosheger, Georg; Ahrens, H.; Nottrott, Markus; Guder, Wiebke; Dieckmann, Ralf; Hardes, Jendrik

doi:10.1007/s00264-014-2560-2

Cited by 48 publications

(61 citation statements)

References 30 publications

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“…In our cohort, one patient had to undergo a revision, because of a periprosthetic infection. These results are comparable with earlier reports on EPR following tumor resection, which described periprosthetic infections in five out of 100 patients 4 and in one out of 18 patients 27 .…”

Section: Discussionsupporting

confidence: 91%

“…The fact that the core design of all prostheses used in this study has not changed over time, intuitively explains the lack of differences in the functional outcomes of older versus modern prosthetic types. Over the last years, however, inverse modular prostheses, which are highly dependent on DM function, were implemented in oncological surgery and show very promising results in so far limited retrospective reports 27 , 33 , 34 . This development apparently emphasizes the importance of DM and axillary nerve preservation even further 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical and Functional Outcome after Endoprosthetic Reconstruction in Patients with Osteosarcoma of the Humerus

Böhler

Brönimann

Kaider

et al. 2018

Sci Rep

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Endoprosthetic reconstruction (EPR) is the most widely used reconstruction technique after humeral osteosarcoma (OSA). Complications are common and function is often compromised due to the premise of wide resection. In the current study we evaluated (1) the risk of complications after resection and EPR; (2) the functional outcome and how it is influenced by the preservation/resection of deltoid muscle (DM), rotator cuff (RC), axillary nerve or the type of resection (intra-/extraarticular) and (3) if the preservation/resection of DM, RC, axillary nerve or the type of resection has a negative influence on the oncological outcome. We retrospectively evaluated data of 49 patients with humeral OSA. All patients underwent resection and EPR. Complication-free survival according to the ISOLS classification was estimated by a competing risk model. Functional outcome was evaluated by range of motion (ROM) in abduction and the MSTS score. Eleven patients (22%) had at least one complication. The estimated cumulative incidence for the first complication was 18% at one year, 23% at five years, and 28% at ten years, respectively. Soft tissue failure was the most common complication. ROM and MSTS scores were significantly higher in patients where DM and RC (p = 0.043/p = 0.046) and axillary nerve (p = 0.014/p = 0.021) could be preserved. Preservation of these structures had no negative influence on the surgical margins. In conclusion, EPR is a good treatment method with an acceptable complication rate. Preservation of the abductor mechanism, when possible in the setting of obtaining negative margins, provides superior functional outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Surgical and Functional Outcome after Endoprosthetic Reconstruction in Patients with Osteosarcoma of the Humerus

Böhler

Brönimann

Kaider

et al. 2018

Sci Rep

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“…[1,4,13] However, although the shoulder function could be preserved by the conventional PHP, it was unsatisfied because of damage of the abductor mechanisms and the unconstrained design of the prosthesis. Therefore, modified endoprosthetic reconstruction, for example reverse shoulder endoprosthesis, [16,21] using synthetic mesh for enhancing soft-tissue attachment, [10,22] etc, had been reported to improve the functional outcome. In this study, the overall functional outcome was consistent with that in literatures.…”

Section: Discussionmentioning

confidence: 99%

Plate-prosthesis composite reconstruction after large segmental resection of proximal humeral tumors

et al. 2019

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Since the standard reconstructive option after large segmental resection of proximal humeral tumors remained controversial, we designed and applied plate-prosthesis composite (PPC) for this circumstance. The purposes of the study were to: compare the functional outcome, implant survival (IS), surgical risk of PPC with those of conventional proximal humeral prosthesis (PHP); and describe the design and reconstructive procedure of PPC. Twenty patients (11 males, 9 females), who received intraarticular proximal humeral resection without preservation of abductor mechanism, were included in this study, with a mean resection length accounting for 72.5% (range, 61.9–81.8%) of whole humeral length. According to the reconstructive options, we categorized patients into PPC group (9 patients) and PHP group (11 patients). PPC was a semi-custom-made endoprosthesis, with modular proximal part same as PHP and custom-made distal part including dumpy stem and composite lateral anatomic plate for distal humerus. The mechanical prosthetic complication was defined as the imaging evidence regardless of reoperation. The IS was defined as the time from surgery to the occurrence of mechanical prosthetic complication. The mean follow-up time was 40.1 months (range, 14–129). The Musculoskeletal Tumor Society 93 scores of PPC and PHP group showed no significant difference (73.3% vs 70.0%, P = .46). Compared to PHP group, PPC group showed significantly lower mechanical prosthetic complication rates (0 vs 45.4%, P = .03) and better IS (86.0 vs 59.3 ± 21.7 months, P = .028). Moreover, the comparison of surgical time (3.2 vs 3.3 hours, P = .60), blood loss (288.9 vs 376.4 mL, P = .15) and perioperative complication rates (11.1% vs 18.2%, P = .58) between 2 groups showed no differences. For reconstruction after large segmental resection of proximal humeral tumors, PPC achieved better IS while maintained similar functional outcome compared to conventional PHP without influencing the complexity and safety of surgery.

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“…This might be explained by a switch from overhead activities to activities involving the lower extremities and these activities are associated with higher UCLA activity scores [16]. The main key issue for functional outcome of the affected extremity still remains the preservation of the axillary nerve [3].…”

Section: K Original Articlementioning

confidence: 99%

“…The proximal humerus is the third most common site of primary bone sarcomas [1]. Endoprosthetic reconstruction is a successful treatment option for limb reconstruction after bone tumor resection or metastatic disease of the humerus [2][3][4][5][6]. Adequate en bloc resection of the tumor is often accompanied by pronounced loss of soft and bone tissues.…”

Section: Introductionmentioning

confidence: 99%

What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction following primary bone sarcoma resection?

Lang

Kasparek

Synak

et al. 2020

Wien Klin Wochenschr

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Summary Background The aim of the study was to assess (1) sports activity, (2) sports involving the upper extremities, (3) functional outcome and (4) sports-related complications of long-term survivors of primary malignant bone tumors of the proximal humerus. Methods A total of 18 patients with an endoprosthetic reconstruction for primary malignant bone sarcoma of the proximal humerus (8 male, 10 female, mean age 19.9 ± 8.4 years, range 7.8–37.4 years) with an average follow-up of 18.1 ± 7.4 years (range 6.7–29.8 years) were included. The type of sport, frequency, duration of each sport session and the University of California, Los Angeles (UCLA) activity score were assessed before surgery, at 1 year, 3 years and at the latest follow-up. Functional outcome was assessed by the Toronto extremity salvage score (TESS). Results The mean UCLA activity score decreased from 8.0 (±1.3, range 5–9) preoperative to 4.2 (±1.7, range 3–8) at 1‑year follow-up (p < 0.05). After 3 years it increased to 5.1 (±1.75, range 3–8) and further to 7 (±1.8, range 4–9) at the last follow-up. The mean postoperative TESS was 80.8 (±6.4, range 75.7–91.4) at the latest follow-up. Patients who were initially more active without reconstruction including a synthetic mesh were more likely to develop soft tissue complications accompanied by proximal endoprothesis migration. Conclusion Patients with a modular endoprosthetic reconstruction of the humerus following primary bone sarcoma resume participation in sports. Regarding the low incidence of periprosthetic infections, utilization of a synthetic mesh for reconstruction to prevent soft tissue complications in active patients should be considered.

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Improvement of the shoulder function after large segment resection of the proximal humerus with the use of an inverse tumour prosthesis

Cited by 48 publications

References 30 publications

Surgical and Functional Outcome after Endoprosthetic Reconstruction in Patients with Osteosarcoma of the Humerus

Surgical and Functional Outcome after Endoprosthetic Reconstruction in Patients with Osteosarcoma of the Humerus

Plate-prosthesis composite reconstruction after large segmental resection of proximal humeral tumors

What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction following primary bone sarcoma resection?

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