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

Abstract

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.

Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma

“…On the other hand, there was no correlation between extent of stress shielding and the duration of follow-up (p = 0.17). With the numbers available, there was no difference regarding the extent of stress shielding between patients with extra-articular resections compared to intra-articular resections (17% (8-24 vs. 12% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), p = 0.43) and with respect to the use of reverse total shoulder arthroplasty compared to anatomical hemiprostheses (14% (IQR 10-29) vs. 12% (6-21), p = 0.47). Additionally, the ratio of stem length to the length of extramedullary reconstruction was not higher in patients with an extent of stress shielding > 50% (1.93 (IQR 1.61-2.43) vs. 2.26 (IQR 1.87-2.53), p = 0.46).…”

“…The reconstruction of bone defects after resection of malignant bone tumors using megaprosthetic PHR has become a frequently used approach with favorable results in several studies despite potential long-term complications [ 6 , 20 , 24 , 25 , 26 ]. However, considering that this procedure is still relatively rare, there are few studies that investigate individual failure modes, particularly aseptic loosening or failure of the bone–implant interface [ 11 , 27 , 28 ].…”

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

“…Adequate en bloc resection of the tumor is often accompanied by pronounced loss of soft and bone tissues. Therefore, these procedures result in a loss of function of the involved extremity [ 7 ]. Moreover, chemotherapy has a negative impact on metabolic function and muscle strength, resulting in prolonged rehabilitation [ 8 , 9 ].…”

<p>Isovitexin Suppresses Cancer Stemness Property And Induces Apoptosis Of Osteosarcoma Cells By Disruption Of The DNMT1/miR-34a/Bcl-2 Axis</p>

“…Osteosarcoma (OS) is a common bone derived malignant cancer represents a disease with high incidence rates in children and young adults 1,2. No significant improvements with regard to the long-term survival of the patients with OS have been reported due to metastases at initial diagnosis and due to the lack of sensitivity to chemotherapy with current therapeutic regimens 3.…”