title: Proximal humeral replacement using a fixed-fulcrum endoprosthesis.
abstract: Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation.
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. dylgrif@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Griffiths
authors.forename: P D
authors.initials: PD
authors.lastname: Gikas
authors.forename: C
authors.initials: C
authors.lastname: Jowett
authors.forename: L
authors.initials: L
authors.lastname: Bayliss
authors.forename: W
authors.initials: W
authors.lastname: Aston
authors.forename: J
authors.initials: J
authors.lastname: Skinner
authors.forename: S
authors.initials: S
authors.lastname: Cannon
authors.forename: G
authors.initials: G
authors.lastname: Blunn
authors.forename: T W R
authors.initials: TW
authors.lastname: Briggs
authors.forename: R
authors.initials: R
authors.lastname: Pollock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D006801:Humans; D006811:Humerus / Q000601:surgery*; D007595:Joint Prosthesis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011474:Prosthesis Design; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult