The Bateman-Type Soft Tissue Reconstruction around Proximal or Total Humeral Megaprostheses in Patients with Primary Malignant Bone Tumors—Functional Outcome and Endoprosthetic Complications

Ahrens, H.; Theil, Christoph; Gosheger, Georg; Rödl, Robert; Deventer, Niklas; Rickert, Carolin; Ackmann, Thomas; Schwarze, Jan; Klingebiel, Stephan; Schneider, Kristian Nikolaus

doi:10.3390/cancers13163971

Cited by 7 publications

(15 citation statements)

References 30 publications

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“…The main mode of failure in most studies was tumor progression (type 5) 3,6,13,17,19 , occurring in 10% 17 to 50% 13,19 of patients in these studies. The second most frequent mode of failure was prosthetic infection (type 4) 4,13 , occurring in 16.1% 13 to 50% of cases 13 . In 1 study, soft-tissue failures (Henderson type 1) occurred in 11% of cases and were the most common mode of failure 5 .…”

Section: Resultsmentioning

confidence: 89%

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Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb

Gonzalez,

Werenski,

Lozano-Calderon

2024

JBJS Reviews

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Background: Total humerus replacement (THR) is a reconstruction procedure performed after resection of massive humeral tumors. However, there is limited literature on the rates of failure and functional outcomes of this implant. Our study aimed to determine the main failure modes, implant survival, and postoperative functional outcomes of THR. Methods: A comprehensive search of the PubMed and Embase databases was conducted. We registered our study on PROSPERO (448684) and used the Strengthening the Reporting of Observational Studies in Epidemiology checklist for quality assessment. The Henderson classification was used to assess endoprosthesis failure and the Musculoskeletal Tumor Society (MSTS) score for functional outcomes. Weighted means and standard deviations were calculated. Results: Ten studies comprising 171 patients undergoing THR were finally included. The overall failure rate was 32.2%. Tumor progression (12.6%) and prosthetic infections (9.4%) were the most common failure modes, followed by soft-tissue failures (5.9%), aseptic loosening (3.5%), and structural failure (1.8%). Two-year, 5-year, and 10-year implant survival rates for the entire cohort were 86%, 81%, and 69.3%. Ten-year implant survival for primary THRs was 78.3%, compared with 38.6% for revision THRs (p = 0.049). The mean MSTS score at the last follow-up was 77%. Patients whose implants did not fail had a higher MSTS score (79.3%) than those with failed implants (71.4%) (p = 0.02). Conclusion: One-third of THR will fail, mostly due to tumor progression and prosthetic infection. Overall functional scores were acceptable, with MSTS scores displaying great hand and elbow function but limited shoulder function. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 89%

“…Ten-year implant survival was reported in 6 studies 3,5,7,13,17,20 and ranged from 47% 13 to 100% 20 . For the entire cohort, 2-year implant survival was 86% (95% confidence interval [CI], 77.3%-91.5%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb

Gonzalez,

Werenski,

Lozano-Calderon

2024

JBJS Reviews

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“…Therefore, it is not easy to perform a large-scale statistical analysis. However, compiling and comparing the function of traditional surgical approaches (anatomic endoprostheses, osteoarticular allografts, and allograftprosthetic composites) with that of reverse shoulder arthroplasty in different articles also revealed significant differences (1,5,(13)(14)(15)(16)(17)(18)(19)(20)(21). For the traditional surgical approach and the reverse shoulder replacement, mean MSTS scores were 69.5% and 69.7%; mean complication rates were 46.8°and 28°; mean anterior flexion angles were 50.9°and 93.2°; mean abduction angles were 34.5°and 112.5°, and mean external rotation angles were 14.3°and 29.2°.…”

Section: Discussionmentioning

confidence: 99%

Early functional and therapeutic effect of reversed tumour shoulder prosthesis reconstruction after proximal humerus tumour resection

Wang

Luo²,

Wang³

et al. 2022

Front. Surg.

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IntroductionReconstruction of proximal humeral tumours after resection is still controversial. And there are few articles describing oncology patients' postoperative function after reversed tumour shoulder prosthesis reconstruction. We investigated the functional results of patients who underwent reversed tumour shoulder prosthesis, including those who did not preserve the deltoid ending point.Patients and methodsWe retrospectively evaluated 16 patients with proximal humerus tumours who had undergone reversed tumour shoulder prosthesis. All patients underwent type Malawer I proximal humeral resection surgery and standard reverse tumour shoulder arthroplasty with a modular reverse shoulder prosthesis. We sutured the severed end of the deltoid to the brachialis muscle using the artificial patch for patients who had their deltoid ending point resected. Patients are rehabilitated and followed up according to our instructions.ResultAll patients were followed up for a mean of 27.4 months (13–59), and their mean age was 45.9 years (15–74). The mean length of the humeral resection was 11.6 cm (5–15). The mean shoulder mobility was 122° (82°–180°) in forward flexion; 39° (31°–45°) in posterior extension; 102° (65°–172°) in abduction; 43° (30°–60°) in external rotation; 83° (61°–90°) in internal rotation, and a mean MSTS score of 77.9% (63.3%–93.3%). The mean DASH score was 20.8 (2.5–35.8). The mean VAS score was 0.9. For patients who had their deltoid ending point resected, the mean length of the humeral resection was 14.0 cm; the mean shoulder mobility was 109° in forward flexion; 37.8° in posterior extension; 102.0° in abduction; 38.3° in external rotation; 86.3° in internal rotation, and the mean MSTS score was 78.8%; the mean DASH score was 21.6; the mean VAS score was 1.0.ConclusionPatients who underwent reverse tumour shoulder arthroplasty can achieve good early postoperative function, survival rate and low complication rate. In addition, patients who had their deltoid ending point removed also obtained good function after particular reconstruction.

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“…While there is currently no robust evidence that this additional foreign material is associated with an increased probability of infection [ 22 ], surgeons should be aware of the fact that the increased surface area carries the risk of bacterial adhesion and removal of the mesh may be required in revision surgery in cases of infection. Furthermore, a modified acromion and musculus trapezius transfer in conjunction with megaprosthetic reconstruction has been described although the potential gain in function was limited and the infection rate was high [ 24 ].…”

Section: Upper Extremitymentioning

confidence: 99%

Implant Survival, Clinical Outcome and Complications of Megaprosthetic Reconstructions Following Sarcoma Resection

Theil¹,

Schwarze²,

Gosheger³

et al. 2022

Cancers

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Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions.

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The Bateman-Type Soft Tissue Reconstruction around Proximal or Total Humeral Megaprostheses in Patients with Primary Malignant Bone Tumors—Functional Outcome and Endoprosthetic Complications

Cited by 7 publications

References 30 publications

Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb

Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb

Early functional and therapeutic effect of reversed tumour shoulder prosthesis reconstruction after proximal humerus tumour resection

Implant Survival, Clinical Outcome and Complications of Megaprosthetic Reconstructions Following Sarcoma Resection

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