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

Abstract

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.

Efficacy and safety of a 3D-printed arthrodesis prosthesis for reconstruction after resection of the proximal humerus: preliminary outcomes with a minimum 2-year follow-up

“…In this study, the results showed that this new prosthesis did not significantly increase the operative time (151.5 min) or intraoperative hemorrhage (410 ml), indicating equivalent perioperative safety of the arthrodesis prosthesis. The mean MSTS-93 (83%) and ASES scores (79.4), as well as the ranges of flexion (71.3°) and abduction (61.3°) of this new prosthesis, were also comparable with those of our previous study and those of other studies [ 1 – 3 , 21 ].…”

“…Resection of the proximal humerus followed the same procedures as previously reported [ 3 , 21 ]. After removal of the tumor, we first dissected the joint capsule to expose the edge of the glenoid, after which we removed the articular cartilage and burnished the subchondral bone until spotty hemorrhage was seen.…”

Computer‐aided Design and 3D‐printed Personalized Stem‐plate Composite for Precision Revision of the Proximal Humerus Endoprosthetic Replacement: A Technique Note

“…However, for PHER, aseptic loosening is uncommon, and there are only a few studies that investigate this failure mode. 10,11,17 Further analysis revealed that periprosthetic osteolysis due to stress shielding was an important reason for aseptic loosening.…”

“…In addition, revision for loosened PHER remains challenging due to the rarity of this complication in PHER. Until now, few publications have specifically addressed the aseptic loosening of PHER 11,17,18 (Table 1). Wei et al described a simple revision technique that a bone cement spacer was implanted to reconstruct the bone defect after taking out the loosened PHER.…”

Radiographic Assessment of Bilateral Asymmetry in the Upper Extremities of Living Humans

“…Congenital defects, tumor resection, or traumatic injury may cause length alterations and/or segmental bone defects that may require reconstruction. In order to achieve the maximum function of the affected limb, physicians must make treatment decisions regarding the appropriate length to optimize outcomes in these populations [7][8][9]. Thus, it is important to understand the degree of normal, non-pathological bilateral asymmetry in post-industrial humans as it may influence decisions regarding operative versus nonoperative treatment.…”