Custom endoprosthetic reconstruction for malignant bone disease in the humeral diaphysis.

The optimal reconstructive method following segmental resection of malignant tumours in the humeral diaphysis is unknown as there are no prospective long-term studies comparing biologic with endoprosthetic reconstruction. This is a retrospective review of 13 patients who, between 1995 and 2010, had undergone limb salvage at our institution using a custom-made humeral diaphyseal endoprosthetic replacement following excision of malignant bone disease. There were 9 males and 4 females with a mean age of 35 years at the time of surgery (range: 10 to 78). Mean follow-up was 56.8 months (range: 5 to 148). Cumulative patient survival was 75% at 10 years. Implant survival, with removal of the endoprosthesis or part of it for any reason as an end point, was 47% at 10 years. Seven patients required revision (54%). Complications included metastases in four, aseptic loosening in four, peri-prosthetic fracture in two and local recurrence in two. Mean MSTS and TESS scores were 23 (18 to 27) and 67% (52-80) respectively. Custom-made humeral diaphyseal replacement following resection of malignant bone tumours provided functional results superior to amputation, without an obvious compromise in patient survival. There was a relatively high revision rate for aseptic loosening and peri-prosthetic fracture and patients should be counselled about this preoperatively.

[1]  S. Cannon,et al.  Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours. , 2010, The Journal of bone and joint surgery. British volume.

[2]  G. Blunn,et al.  Non-invasive extendible endoprostheses for limb reconstruction in skeletally-mature patients. , 2009, The Journal of bone and joint surgery. British volume.

[3]  G. Blunn,et al.  The early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation. , 2009, The Journal of bone and joint surgery. British volume.

[4]  K. S. Hall,et al.  Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. , 2008, The Journal of bone and joint surgery. British volume.

[5]  P. Stalley,et al.  Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery. , 2007, The Journal of bone and joint surgery. British volume.

[6]  Constance M. Chen,et al.  Reconstruction of Extremity Long Bone Defects after Sarcoma Resection with Vascularized Fibula Flaps: A 10-Year Review , 2007, Plastic and reconstructive surgery.

[7]  E. Ahlmann,et al.  Intercalary endoprosthetic reconstruction for diaphyseal bone tumours. , 2006, The Journal of bone and joint surgery. British volume.

[8]  K. Weber,et al.  Use of a Vascularized Fibula Bone Flap and Intercalary Allograft for Diaphyseal Reconstruction after Resection of Primary Extremity Bone Sarcomas , 2005, Plastic and reconstructive surgery.

[9]  H J Mankin,et al.  Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. , 2005, The Journal of bone and joint surgery. American volume.

[10]  R. Brand,et al.  Epidiaphyseal versus Other Intercalary Allografts for Tumors of the Lower Limb , 2005, Clinical orthopaedics and related research.

[11]  T. H. Chen,et al.  Reconstruction after intercalary resection of malignant bone tumours: comparison between segmental allograft and extracorporeally-irradiated autograft. , 2005, The Journal of bone and joint surgery. British volume.

[12]  R. Davidson,et al.  Reconstruction of an Intercalary Defect with Bone Transport after Resection of Ewing???s Sarcoma , 2005 .

[13]  R. Grimer,et al.  Endoprosthetic replacement of diaphyseal bone defects. Long-term results , 2005, International Orthopaedics.

[14]  D. Muscolo,et al.  Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections , 2004, Clinical orthopaedics and related research.

[15]  E. Gur,et al.  Free Fibula Long Bone Reconstruction in Orthopedic Oncology: A Surgical Algorithm for Reconstructive Options , 2004, Plastic and reconstructive surgery.

[16]  H. Mankin,et al.  Comparison of Quality of Life After Amputation or Limb Salvage , 2002, Clinical orthopaedics and related research.

[17]  H J Mankin,et al.  Factors Affecting Nonunion of the Allograft-Host Junction , 2001, Clinical orthopaedics and related research.

[18]  P. Picci,et al.  Massive Bone Allograft Reconstruction in High-Grade Osteosarcoma , 2000, Clinical orthopaedics and related research.

[19]  A. Garg,et al.  Fractures in Large Segment Allografts , 2000, Clinical orthopaedics and related research.

[20]  H. Yoshikawa,et al.  Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. , 1999, Clinical orthopaedics and related research.

[21]  H. Mankin,et al.  Magnetic resonance imaging features of allografts , 1999, Skeletal Radiology.

[22]  P. Pynsent,et al.  The cost-effectiveness of limb salvage for bone tumours. , 1997, The Journal of bone and joint surgery. British volume.

[23]  H. Tsuchiya,et al.  Limb Salvage Using Distraction Osteogenesis: A Classification Of The Technique , 1997 .

[24]  H J Mankin,et al.  The Results of Transplantation of Intercalary Allografts after Resection of Tumors. A Long-Term Follow-Up Study* , 1997, The Journal of bone and joint surgery. American volume.

[25]  C. Bombardier,et al.  Development of a measure of physical function for patients with bone and soft tissue sarcoma , 1996, Quality of Life Research.

[26]  R. Grimer,et al.  THE OUTCOME AND FUNCTIONAL RESULTS OF DIAPHYSEAL ENDOPROSTHESES AFTER TUMOUR EXCISION , 1996 .

[27]  H J Mankin,et al.  Long-Term Results of Allograft Replacement in the Management of Bone Tumors , 1996, Clinical orthopaedics and related research.

[28]  K. An,et al.  Intercalary Spacers in the Treatment of Segmentally Destructive Diaphyseal Humeral Lesions in Disseminated Malignancies , 1996, Clinical orthopaedics and related research.

[29]  J. Healey,et al.  Allograft reconstruction after proximal tibial resection for bone tumors. An analysis of function and outcome comparing allograft and prosthetic reconstructions. , 1994, Clinical orthopaedics and related research.

[30]  M. Simon,et al.  Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. , 1994, The Journal of bone and joint surgery. American volume.

[31]  D. Campanacci,et al.  The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study. , 1993, La Chirurgia degli organi di movimento.

[32]  W. Enneking,et al.  Observations on massive retrieved human allografts. , 1991, The Journal of bone and joint surgery. American volume.

[33]  M. Gebhardt,et al.  The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. , 1991, Clinical orthopaedics and related research.

[34]  W. Enneking,et al.  A System for the Surgical Staging of Musculoskeletal Sarcoma , 1980, Clinical orthopaedics and related research.

[35]  D. Campanacci,et al.  A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. , 2007, The Orthopedic clinics of North America.

[36]  B. Alman,et al.  Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. , 1995, The Journal of bone and joint surgery. American volume.

[37]  W. Enneking,et al.  A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. , 1993, Clinical orthopaedics and related research.