title: Custom endoprosthetic reconstruction for malignant bone disease in the humeral diaphysis.
abstract: 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.
authors.affiliation: London Bone and Soft Tissue Tumour Service, The Royal National Orthopaedic Hospital, Stanmore, U.K. anthonymcgrath@nhs.net
authors.forename: Anthony
authors.initials: A
authors.lastname: McGrath
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sewell
authors.forename: Sammy A
authors.initials: SA
authors.lastname: Hanna
authors.forename: Robin C
authors.initials: RC
authors.lastname: Pollock
authors.forename: John A
authors.initials: JA
authors.lastname: Skinner
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cannon
authors.forename: Timothy W R
authors.initials: TW
authors.lastname: Briggs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery; D055815:Young Adult