title: Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint.
abstract: BACKGROUND
  Reconstruction of large bone defects around the elbow joint is surgically demanding due to sparse soft tissue coverage, complex biomechanics and the close proximity to neurovascular structures. Modular megaprostheses are established reconstruction tools for the elbow, but only small case series have been reported in the literature.
  
  
  METHODS
  Thirty-six patients who underwent reconstruction of the elbow joint with a modular megaprosthesis were reviewed retrospectively. In 31 patients (86.1%), elbow replacement was performed after resection of a bone tumour, whereas five non-oncological patients (13.9%) underwent surgery because of a previous failed elbow reconstruction. Functional outcome, rate of complications and oncological results were considered as primary endpoints.
  
  
  RESULTS
  The mean follow-up was 25 months. The average achieved Mayo Elbow Performance Score (MEPS) was 77.08 (range 40-95) and the average Musculoskeletal Tumor Society (MSTS) score was 22.9 (range 8-30). Six complications (16.7%) were observed: two radial palsies, one temporary radial nerve dysfunction, one ulnar palsy, one disassembling of the articular prosthesis component and one deep infection necessitating the only implant removal. The overall 5-year survival rate of the patients was poor (25.1%) because of rapid systemic progression of the oncological disease in patients with metastatic lesion. However, the 5-year survival rate of the implant was very satisfactory (93%).
  
  
  CONCLUSIONS
  Modular megaprosthesis is a reliable and effective reconstruction tool in large bone defects around the elbow joint. The complication rates are lower than seen in osteoarticular allografts and allograft-prosthesis composites while the functional outcome is equal. In palliative situations with metastatic disease involving the elbow, modular megaprosthesis enables rapid recovery and pain relief and preserves elbow function.
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Capanna
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Muratori
authors.affiliation: Department of Orthopaedic and Traumatology, University of Messina, Italy.
authors.forename: Francesco R
authors.initials: FR
authors.lastname: Campo
authors.affiliation: Department of Orthopaedic and Traumatology, University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Arienzo
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Frenos
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Beltrami
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Scoccianti
authors.affiliation: Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cuomo
authors.affiliation: Oncologic Centre "Palazzo Baleani", Azienda Policlinico Umberto I, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Piccioli
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland. Electronic address: daniel.mueller@balgrist.ch.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone tumour; Complex fracture; Distal humerus; Elbow; Modular megaprosthesis; Reconstruction