title: Total elbow arthroplasty for primary and metastatic tumor.
abstract: Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses.
  
  
  
  Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control.
  
  
  
  Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17.
  
  
  
  At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%) radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%) partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean of 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%).
  
  
  
  Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms.
  
  
  
  Therapeutic.
  
  
  
  IV, retrospective study.
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. Electronic address: roberto.casadei@ior.it.
authors.forename: R
authors.initials: R
authors.lastname: Casadei
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. Electronic address: massimiliano.depaolis@ior.it.
authors.forename: M
authors.initials: M
authors.lastname: De Paolis
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. Electronic address: gabriele.drago@ior.it.
authors.forename: G
authors.initials: G
authors.lastname: Drago
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. Electronic address: carlo.romagnoli@ior.it.
authors.forename: C
authors.initials: C
authors.lastname: Romagnoli
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. Electronic address: davide.donati@ior.it.
authors.forename: D
authors.initials: D
authors.lastname: Donati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000295:instrumentation* / Q000379:methods; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D002648:Child; D004551:Elbow Joint / Q000601:surgery*; D058569:Elbow Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000556:secondary / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Elbow; Limb-salvage; Metastases; Modular prosthesis; Prosthesis; Tumors