Allograft-prosthesis composite reconstruction of the proximal part of the humerus: surgical technique Journal Article

Authors: Abdeen, A.; Healey, J. H.
Article Title: Allograft-prosthesis composite reconstruction of the proximal part of the humerus: surgical technique
Abstract: BACKGROUND: Limb salvage following resection of a tumor in the proximal part of the humerus poses many challenges. Reconstructive options are limited because of the loss of periarticular soft-tissue stabilizers of the glenohumeral joint in addition to the loss of bone and articular cartilage. The purpose of this study was to evaluate the functional outcome and survival of the reconstruction following use of a humeral allograft-prosthesis composite for limb salvage. METHODS: An allograft-prosthesis composite was used to reconstruct a proximal humeral defect following tumor resection in thirty-six consecutive patients at one institution over a sixteen-year period. The reconstruction was performed at the time of a primary tumor resection in thirty cases, after a failure of a reconstruction following a previous tumor resection in five patients, and following excision of a local recurrence in one patient. The mean duration of follow-up of the living patients was five years. Glenohumeral stability, function, implant survival, fracture rate, and union rate following the reconstructions were measured. Functional outcome and implant survival were analyzed on the basis of the amount of deltoid resection, whether the glenohumeral resection had been extra-articular or intra-articular, and the length of the humerus that had been resected. RESULTS: One patient sustained a glenohumeral dislocation. Deltoid resection (partial or complete) resulted in a reduced postoperative range of motion in flexion and abduction but had no effect on the mean Musculoskeletal Tumor Society score. Extraarticular resections were associated with lower Musculoskeletal Tumor Society scores. All patients had either mild or no pain and normal hand function at the time of final follow-up. The overall estimated rate of survival of the construct, with revision as the end point, was 88% at ten years. There were three failures due to progressive prosthetic loosening that necessitated removal of the construct. Four patients required an additional bone-grafting procedure to treat a delayed union of the osteosynthesis site. CONCLUSIONS: An allograft-prosthesis composite used for limb salvage following tumor resection in the proximal part of the humerus is a durable construct associated with an acceptable complication rate. Deltoid preservation and intra-articular resection are associated with a greater range of shoulder motion and a superior functional outcome, respectively. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.
Keywords: survival; clinical article; human tissue; treatment outcome; bone neoplasms; antibiotic agent; bone tumor; cancer surgery; functional assessment; hand function; humerus; limb salvage; osteosynthesis; range of motion; shoulder; shoulder dislocation; surgical technique; survival rate; treatment failure; bone transplantation; reconstructive surgical procedures; recovery of function; transplantation, homologous; clinical trial; cancer recurrence; plastic surgery; follow up; methodology; follow-up studies; cohort studies; cohort analysis; pathology; risk assessment; postoperative complication; rating scale; convalescence; prosthesis; prosthesis loosening; pain assessment; allotransplantation; cephalosporin; implantation; prostheses and implants; prosthesis design; abduction; bone allograft; bone prosthesis; elbow flexion; fracture healing; fracture nonunion; humerus fracture; joint stability; shoulder surgery; prostheses and orthoses; prosthesis implantation; shoulder joint
Journal Title: Journal of Bone and Joint Surgery
Volume: 92
Issue: Suppl. 1 Part 2
ISSN: 0021-9355
Publisher: Journal of Bone and Joint Surgery  
Date Published: 2010-09-01
Start Page: 188
End Page: 196
Language: English
DOI: 10.2106/jbjs.j.00167
PUBMED: 20844174
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: JBJSA" - "Source: Scopus"
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MSK Authors
  1. John H Healey
    494 Healey