Proximal humeral replacement using a fixed-fulcrum endoprosthesis

Griffiths, David; Gikas, Panagiotis D.; Jowett, Charlie; Bayliss, Lee; Aston, William; Skinner, John; Cannon, Stephen R.; Blunn, Gordon; Briggs, Timothy; Pollock, Rob

doi:10.1302/0301-620x.93b3.24421

Cited by 38 publications

(30 citation statements)

References 21 publications

(26 reference statements)

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“…22 The non-weight-bearing function of the humerus should also contribute to a lesser incidence of loosening and breakage when compared to the lower limb. 4,5,11 Although the numbers are small we believe that this study adds to the existing literature on use of massive endoprostheses in limb salvage in the upper limb, especially in primary malignant tumours. The successful use of locally manufactured prostheses demonstrates that cost constraints need no longer be an insurmountable barrier in populations with limited resources.…”

Section: Discussionmentioning

confidence: 91%

“…9,10 Conventionally rather than use a measurement of range of movement of the shoulder, the focus is on function scores. 11 All patients had limited shoulder function with passive movement exceeding active movement and none could actively elevate their arm above shoulder level. Some also had less than full extension of the elbow but all had good hand function.…”

Section: Resultsmentioning

confidence: 99%

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The results of total humeral replacement following excision for primary bone tumour

Puri

Gulia

2012

The Journal of Bone and Joint Surgery. British volume

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Rarely, the extent of a malignant bone tumour may necessitate resection of the complete humerus to achieve adequate oncological clearance. We present our experience with reconstruction in such cases using a total humeral endoprosthesis (THER) in 20 patients (12 male and eight female) with a mean age of 22 years (6 to 59). We assessed the complications, the oncological and functional outcomes and implant survival. Surgery was performed between June 2001 and October 2009. The diagnosis included osteosarcoma in nine, Ewing's sarcoma in eight and chondrosarcoma in three. One patient was lost to follow-up. The mean follow-up was 41 months (10 to 120) for all patients and 56 months (25 to 120) in survivors. There were five local recurrences (26.3%) and 11 patients were alive at time of last follow-up, with overall survival for all patients being 52% (95% confidence interval (CI) 23.8 to 74) at five years. The mean Musculoskeletal Tumor Society score for the survivors was 22 (73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3) at five years. The use of a THER in the treatment of malignant tumours of bone is oncologically safe; it gives consistent and predictable results with low rates of complication.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

The results of total humeral replacement following excision for primary bone tumour

Puri

Gulia

2012

The Journal of Bone and Joint Surgery. British volume

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“…With resection of deltoid muscle, rotator cuff and axillary nerve, the prosthesis replacement has to overcome failure of humeral fixation, superior head migration and lack of muscle insertion, finally acting as a passive spacer [7, 16]. Although newer techniques and prosthesis are coming up to meet the deficiencies, it further adds to the cost and requires expertise [16, 17]. …”

Section: Discussionmentioning

confidence: 99%

Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus

Kundu¹,

Gogna²,

Gupta³

et al. 2013

Strategies in Trauma and Limb Reconstruction

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Limb salvage surgery for malignant tumours of proximal humerus is an operative challenge, where the surgeon has to preserve elbow and hand functions and retain shoulder stability with as much function as possible. We treated 14 consecutive patients with primary malignant or isolated metastasis of proximal humerus with surgical resection and reconstruction by nail cement spacer. There were 8 females and 6 males, with a mean age of 28.92 years (range 16–51 years) and a mean follow-up of 30.14 months (range 12–52 months). The diagnosis was osteosarcoma in 8 patients, chondrosarcoma in 4 patients and metastasis from thyroid and breast carcinoma in 1 patient each. One of our patients had radial nerve neuropraxia, 1 developed inferior subluxation and 3 developed distant metastasis. Two patients died of disease and one developed local recurrence leading to forequarter amputation, leaving a total of 11 patients with functional extremities for assessment at the time of final follow-up which was done using the Musculoskeletal Tumour Society (MSTS) score. Though we were able to preserve the elbow, wrist and hand functions in all patients, the abductor mechanism, deltoid muscle and axillary nerve were not salvageable in any of cases. The mean MSTS score at the time of final follow-up was 19.09. Thus, proximal humeral reconstruction using nail cement spacer is a technical simple, cost-effective and reproducible procedure which makes it a reliable option in subset of patients where the functions around the shoulder cannot be preserved despite costlier prosthesis.

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“…16 In tumors of the proximal humerus with large volume disease, extensive involvement of the diaphysis is not infrequent. 16 In tumors of the proximal humerus with large volume disease, extensive involvement of the diaphysis is not infrequent.…”

Section: Inexpensive Humeral Reconstructionsmentioning

confidence: 99%

Options of limb-salvage surgery for late presenting or large malignant bone tumors

Puri¹,

Panchwagh²

2013

Current Orthopaedic Practice

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Lack of education, coupled with apathy, socioeconomic conditions, the need to travel vast geographical distances to access health care, reliance on alternate medical practices, and a shortage of trained orthopaedic oncologists all contribute to late presentations of malignant bone tumors in the developing world. Balancing the two opposing goals of ensuring adequate resection of involved bone and soft tissue so as to minimize the chance of local recurrence while yet preserving adequate function of the limb after reconstruction often can be a challenge, especially in patients with large tumors. In a resource-challenged setting, the ingenuity of the treating team often is tested when deciding on reconstruction modalities, resulting in more inexpensive and locally applicable solutions for limb salvage as compared with conventional modalities. This article seeks to illustrate some such options for limb salvage in late presenting or large malignant bone tumors.

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Proximal humeral replacement using a fixed-fulcrum endoprosthesis

Cited by 38 publications

References 21 publications

The results of total humeral replacement following excision for primary bone tumour

The results of total humeral replacement following excision for primary bone tumour

Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus

Options of limb-salvage surgery for late presenting or large malignant bone tumors

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