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Kinoshita H, Stevenson J, Morris G, Kurisunkal V, Shreemal B, Abudu A. Long-term Outcomes of Biological Reconstruction for Primary Bone Sarcoma of the Humerus. CANCER DIAGNOSIS & PROGNOSIS 2025; 5:153-161. [PMID: 40034949 PMCID: PMC11871867 DOI: 10.21873/cdp.10425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 01/19/2025] [Accepted: 01/20/2025] [Indexed: 03/05/2025]
Abstract
Background/Aim Options for the reconstruction of bone defects following resection of primary bone sarcomas of the humerus include massive endoprostheses or biological reconstruction. We report the oncological, clinical, and functional outcomes in patients treated with biological reconstructions. Patients and Methods This study included 23 consecutive patients with primary bone sarcoma of humerus who underwent en-bloc resection and biological reconstructions at a single institution. Four groups of patients were identified. Group A: twelve patients with vascularized fibula epiphyseal transfer. Group B: four patients with structural grafts with vascularized fibula. Group C: four patients with structural grafts with non-vascularized fibula. Group D: three patients with only structural grafts (allograft or reimplanted bone only). The postoperative oncological outcomes, complications, reoperation rates, and postoperative limb function using the Musculoskeletal Tumor Society (MSTS) scores were evaluated. Results The median age at diagnosis was 8 years (range=3-54 years). The median follow-up was 87 months (range=6-172 months). Graft complications at recipient sites occurred in 13 patients including fracture in seven, non-union in four, and avascular necrosis in two. Donor site peroneal nerve palsy occurred in seven patients. Local recurrence and metastases occurred in one and two patients, respectively. At the last follow-up, twenty‑two patients were alive (21 continuously disease-free for a median of 87 months, and one with no evidence of disease), and one patient died of disease. The mean MSTS scores for all patients was 78.9%, and this was similar in the four groups: 77.5%, 72.5%, 85.8%, and 83.3% in Groups A, B, C, and D, respectively. Conclusion Biological reconstruction of the humerus is a complex procedure with a risk of complications but has good oncological and functional outcomes.
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Affiliation(s)
- Hideyuki Kinoshita
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
- Chiba Cancer Center, Chiba, Japan
| | - Jonathan Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
- Aston University Medical School, Birmingham, U.K
| | - Guy Morris
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
| | - Vineet Kurisunkal
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
| | - Bhim Shreemal
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
- Christian Medical College, Vellore, India
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, U.K
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Su F, Garcia-Lopez E, Wustrack R, Lansdown DA. Endoprosthetic Reconstruction for Proximal Humerus Tumors. Curr Rev Musculoskelet Med 2025; 18:26-37. [PMID: 39630212 PMCID: PMC11732810 DOI: 10.1007/s12178-024-09933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2024] [Indexed: 01/15/2025]
Abstract
PURPOSE OF THE REVIEW Anatomic and reverse endoprosthetic reconstruction are two common surgical options used after tumor resection of the proximal humerus. The purpose of this article is to provide an overview of the functional outcomes and complications of modern anatomic and reverse endoprostheses. RECENT FINDINGS The anatomic endoprosthesis has traditionally been a successful reconstructive technique as it provided a stable platform upon which the hand and elbow could function. However, the reverse endoprosthesis has gradually replaced the anatomic endoprosthesis given that its semi-constrained design affords greater stability. Patients with reverse endoprostheses have improved motion, patient-reported outcome scores, and revision-free implant survivorship compared to those with anatomic endoprostheses. Shoulder function may be further improved with a reverse allograft prosthetic composite (APC) due to reconstruction of the rotator cuff tendons or by transferring the latissimus dorsi and teres major tendons to recreate the function of the posterosuperior rotator cuff muscles. The short-term functional improvement observed with the use of an allograft reconstruction, however, may diminish with longer follow-up due to delayed graft complications, such as resorption, nonunion, and fracture. In most patients undergoing oncologic resection of the proximal humerus, the reverse endoprosthesis or reverse APC is recommended due to improved functional outcomes and reduced postoperative complications compared to other reconstructive techniques.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320W, San Francisco, CA, 94143-0728, USA.
| | - Edgar Garcia-Lopez
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320W, San Francisco, CA, 94143-0728, USA
| | - Rosanna Wustrack
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320W, San Francisco, CA, 94143-0728, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320W, San Francisco, CA, 94143-0728, USA
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Muacevic A, Adler JR, Sakhre R. En Bloc Resection With Reconstruction Using a Customized Megaprosthesis in a Case of Proximal Humerus Giant Cell Tumor: A Case Report. Cureus 2023; 15:e34217. [PMID: 36852360 PMCID: PMC9958242 DOI: 10.7759/cureus.34217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
A giant cell tumor is a common, benign but locally aggressive bone tumor faced by orthopedic surgeons. The proximal humerus is a rare site of occurrence for this tumor, and the challenges posed while approaching such a case are discussed in this report of a 29-year-old male who presented with pain, swelling, and restricted motion at the left shoulder. Plain radiographs and MRI were suggestive of an aggressive giant cell tumor of the proximal humerus, which was confirmed on histopathological examination. Due to the lesion's extensive soft-tissue involvement, en-bloc resection with reconstruction was planned, but due to the COVID-19 pandemic, surgery was delayed. During the same period, the patient had trivial trauma to the same shoulder, following which the size of the lesion began increasing. The patient was operated on with en-bloc resection and reconstruction with a custom megaprosthesis; following the surgery, there was a complete resolution of pain and improvement in the range of motion. En bloc resection and replacement with a customized megaprosthesis, though technically demanding, offer a safe and cost-effective modality for limb salvage surgery for large giant cell tumors, with good functional outcomes and decreased chances of recurrence.
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Affiliation(s)
- Alexander Muacevic
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
| | - John R Adler
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Reconstruction Using Free Vascularized Fibular Grafts after Wide Resection of Humerus Chondrosarcoma in a Patient with Cleidocranial Dysplasia. Case Rep Orthop 2021; 2021:2302879. [PMID: 33747589 PMCID: PMC7960051 DOI: 10.1155/2021/2302879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 01/23/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
Cleidocranial dysplasia is characterized by hypoplasia of the clavicles, unerupted teeth, narrow pelvis, short stature, and craniofacial malformations. A cause of this skeletal dysplasia is heterozygous mutations of the runt-related transcription factor 2 gene (Runx2), a master regulator for bone and cartilage development. Chondrosarcoma is a primary malignant bone tumor that is usually treated by wide resection surgery. This report shows a case of a 25-year-old female patient with cleidocranial dysplasia who was affected with chondrosarcoma of the left humerus. We performed wide resection of the tumor and reconstruction of the large bone defect of the humerus using free vascularized fibular grafts. The patient preserved the hand function and activity of daily life as the same level as preoperative condition more than five years after the surgery.
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Yang Y, Li Y, Liu W, Niu X. Mesh patch and anchors can improve clinical results of prosthetic replacement after resection of primary proximal humerus malignant tumor. Sci Rep 2021; 11:734. [PMID: 33436664 PMCID: PMC7804124 DOI: 10.1038/s41598-020-78959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the functional results, complications and related factors of prosthesis reconstruction after malignant tumor resection of primary proximal humeral, and also evaluate whether soft tissue reconstruction with mesh patch and anchors can improve clinical results. From 2002 to 2016, forty-one patients were enrolled in this study. The pathological diagnosis contained 27 cases of osteosarcoma, 7 cases of chondrosarcoma and other primary malignant bone tumors. Both mesh patch and anchors were used in the reconstruction of joint capsule and the surrounding soft tissues in 27 cases. The mean postoperative follow-up was 60.6 months. The average active abduction angle and passive abduction angle was 33.5 (5–71) degrees and 72.4 (52–104) degrees. The prosthetic humeral head displacement was over 2 cm in 5 cases (12.2%). The average MSTS score was 23.1. The overall 5-year survival rate of prosthesis was 88.2%. The length of osteotomy, whether preserving deltoid muscle, whether applying mesh patch and anchors had significant effects on the abduction angle of shoulder joint; the length of osteotomy, whether applying mesh patch and anchors had significant effects on the degree of upward displacement of prosthesis. The application of both mesh patch and anchors in prosthesis reconstruction achieved more stable result and better function of shoulder joint. To ensure the stability of shoulder joint and the firm wrapping of surrounding soft tissue are key factors affecting the postoperative function.
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Affiliation(s)
- Yongkun Yang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Weifeng Liu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China.
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Landau MJ, Badash I, Yin C, Alluri RK, Patel KM. Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications. J Surg Oncol 2018. [PMID: 29513891 DOI: 10.1002/jso.25032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascularized bone grafting after tumor resection can be an important component in the treatment of bony neoplasms of the upper extremity. The purpose of this study was to determine the outcomes of free vascularized fibula grafting (FVFG) in the treatment of upper extremity sarcomas. METHODS A systematic review of the literature of FVFG used in the treatment of upper extremity sarcomas was performed. RESULTS A total of 56 studies were included in final analysis. The most common diagnosis was osteosarcoma (35.1%) and the most common recipient site was the humerus (57.3%). FVFG had a median union rate of 93.3%, with the median time to union being 5.0 months. The most common complications were fracture (11.7%), nerve injury (7.5%), infection (5.7%), and hammer toe deformity (3.3%). The reoperation rate was 34.5%. The most commonly reported standardized assessment of clinical outcomes following treatment was the Musculoskeletal Tumor Society Score, which had a median of 80% postoperatively. CONCLUSIONS FVFG in the treatment of malignant bony neoplasms of the upper extremity has a high rate of union and good overall outcomes; however, postoperative complication rates are high. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.
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Affiliation(s)
- Mark J Landau
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Christine Yin
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
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Reverse shoulder endoprosthesis for pathologic lesions of the proximal humerus: a minimum 3-year follow-up. J Shoulder Elbow Surg 2017; 26:1990-1994. [PMID: 28684229 DOI: 10.1016/j.jse.2017.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Bayley Walker (Stanmore Implants, Elstree, UK) reversed polarity, linked shoulder replacement is designed to provide stable function in the treatment of a painful shoulder with poor soft tissue coverage. We reviewed the results of the prosthesis in destructive pathologic lesions of the proximal humerus at a United Kingdom tumor center. METHODS We identified 8 patients (2 men, 6 women) in our database. Clinical information and functional outcome scores were collected, including range of movement, Toronto Extremity Salvage Score, the Musculoskeletal Tumor Score. Radiographs from the last clinic follow-up were analyzed. RESULTS Of the 8 patients, 2 were revisions for aseptic loosening around proximal humeral endoprosthetic replacements. Indications for surgery included chondrosarcoma in 4, metastatic disease in 2, Ewing sarcoma in 1, and osteomyelitis in 1. Patients were a mean age at diagnosis of 49 years (range, 16-78 years). One patient died of metastatic disease during follow-up. Mean follow-up was 49 months (range, 36-90 months). At the latest follow-up, there was 100% survivorship using revision as the end point. There were no local recurrences. Three of 5 patients returned to their previous occupation. Neuropathic pain developed in 1 patient postoperatively, but no other postoperative complications were noted. Radiographs showed no progressive lucencies or scapula notching. Mean range of movement at final follow-up was abduction, 62°; forward flexion, 71°; and external and internal rotation, 50°. CONCLUSION The Bayley Walker prosthesis gives excellent medium-term survivorship and pain relief in patients with pathologic lesions of the proximal humerus requiring wide local excision.
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Dubina A, Shiu B, Gilotra M, Hasan SA, Lerman D, Ng VY. What is the Optimal Reconstruction Option after the Resection of Proximal Humeral Tumors? A Systematic Review. Open Orthop J 2017; 11:203-211. [PMID: 28458733 PMCID: PMC5388785 DOI: 10.2174/1874325001711010203] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/02/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose: The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction. Methods: A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus. Results: A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%). Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA. Discussion: Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.
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Affiliation(s)
- Andrew Dubina
- University of Maryland - Orthopaedics, Baltimore, MD, USA
| | - Brian Shiu
- University of Maryland Medical Center - Orthopaedics, Baltimore, MD, USA
| | - Mohit Gilotra
- University of Maryland Medical Center - Orthopaedics, Baltimore, MD, USA
| | - S Ashfaq Hasan
- University of Maryland Medical Center - Orthopaedics, Baltimore, MD, USA
| | - Daniel Lerman
- University of Maryland Medical Center - Orthopaedics, Baltimore, MD, USA
| | - Vincent Y Ng
- University of Maryland Medical Center - Orthopaedics, 110 S. Paca St, 6th Floor, Baltimore, 21201, MD, USA
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Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases. Case Rep Oncol Med 2016; 2016:4140239. [PMID: 27847662 PMCID: PMC5099472 DOI: 10.1155/2016/4140239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022] Open
Abstract
Clavicula pro humero (CPH) reconstruction is a method that is used after proximal humeral excision. During CPH reconstruction, the ipsilateral clavicle is rotated downward and connected to the preserved distal humerus by using plates and screws. This method is frequently used for reconstruction surgeries involving young patients and has positive outcomes. In this study, we describe two cases of CPH reconstruction that were performed on elderly individuals after wide resection of the proximal humerus; postoperative results from these surgeries were satisfactory. The average Musculoskeletal Tumor Society (MSTS) functional score after surgery was 68.5%, indicating that CPH reconstruction is suitable for not only younger but also elderly patients, particularly those over the age of 65 years.
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Schmolders J, Koob S, Schepers P, Kehrer M, Frey SP, Wirtz DC, Pennekamp PH, Strauss AC. Silver-coated endoprosthetic replacement of the proximal humerus in case of tumour-is there an increased risk of periprosthetic infection by using a trevira tube? INTERNATIONAL ORTHOPAEDICS 2016; 41:423-428. [PMID: 27830274 DOI: 10.1007/s00264-016-3329-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube. METHODS Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube. In 15 further cases the use of a trevira tube was not necessary. The mean follow-up time was 26 months (range: 24 months to 84 months). Both, Enneking score and range of motion (ROM), was evaluated. Further radiographs were obtained in two planes. RESULTS The survival rate one year after surgery was 83 % and 63 % after two years. We recorded a 96 % survival of the limb two years after surgery. We also observed only one case of periprosthetic joint infection (PJI) in the entire follow-up period in one patient who received treatment with a trevira tube. The mean Enneking score was 20 points (range 8 to 26 points). ROM was equal in both study groups. In total 20 % of the treated patients (n = 6) suffered complications. CONCLUSIONS Replacement of the proximal humerus by using a trevira tube in combination with a modular tumour endoprosthesis is a safe and viable treatment option for both, bone tumours and metastases. There is no statistically significant increased risk of infection by using trevira tube even among immunosuppressed patients. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
- Jan Schmolders
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
| | - Sebastian Koob
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Paul Schepers
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Michael Kehrer
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Sönke Percy Frey
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Dieter Christian Wirtz
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Peter Heinrich Pennekamp
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Andreas Christian Strauss
- Department for Orthopaedics und Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
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Stavropoulos NA, Sawan H, Dandachli F, Turcotte RE. Use of Ligament Advanced Reinforcement System tube in stabilization of proximal humeral endoprostheses. World J Orthop 2016; 7:265-271. [PMID: 27114934 PMCID: PMC4832228 DOI: 10.5312/wjo.v7.i4.265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/22/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review outcomes following usage of the Ligament Advanced Reinforcement System (LARS®) in shoulder tumors.
METHODS: Medical records of nineteen patients (19 shoulders) that underwent tumor excisional procedure and reconstruction with the LARS synthetic fabric, were retrospectively reviewed.
RESULTS: Patients’ median age was 58 years old, while the median length of resection was 110 mm (range 60-210 mm). Compared to immediate post-operative radiographs, the prosthesis mean end-point position migrated superiorly at a mean follow up period of 26 mo (P = 0.002). No statistical significant correlations between the prosthesis head size (P = 0.87); the implant stem body length (P = 0.949); and the length of resection (P = 0.125) with the position of the head, were found at last follow up. Two cases of radiological dislocation were noted but only one was clinically symptomatic. A minor superficial wound dehiscence, healed without surgery, occurred. There was no evidence of aseptic loosening either, and no prosthetic failure.
CONCLUSION: LARS® use ensured stability of the shoulder following endoprosthetic reconstruction in most patients.
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Ejiri S, Tajino T, Kawakami R, Hakozaki M, Konno SI. LONG-TERM FOLLOW-UP OF FREE VASCULARIZED FIBULAR HEAD GRAFT FOR RECONSTRUCTION OF THE PROXIMAL HUMERUS AFTER WIDE RESECTION FOR BONE SARCOMA. Fukushima J Med Sci 2015; 61:58-65. [PMID: 26063512 DOI: 10.5387/fms.2015-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study investigated the shape of bone grafts and associations with upper limb function over the long term after free vascularized fibular head graft (FVFHG) for reconstruction of the proximal humerus after wide resection for bone sarcoma. METHODS Patients comprised 3 women who had undergone FVFHG at least 5 years previously. Age at surgery was 12 years in 2 cases and 76 years in one. The mean follow-up periods were 10 years 4 months. Evaluated parameters comprised: 1) graft hypertrophy, and 2) shape of the fibular head as changes in shape of the bone graft; and 3) ISOLS score, and 4) DASH score as indicators of upper limb function. RESULTS Rates of graft hypertrophy of the fibular shaft were -14%, -17%, and -20%, respectively, with transverse diameter decreasing in all cases. In terms of changes in shape of the grafted fibular head, transverse diameter had diminished in 2 patients (-5 mm and -2 mm), and the head had been completely resorbed in the remaining patient. Both patients in whom the fibular head remained were young, and both had good ISOLS scores >80% and good DASH scores of 5.0 and 8.3. The patient in whom the fibular head had been resorbed was elderly, with ISOLS and DASH scores of 73.3% and 34.2, respectively; comparatively poor compared with the other two. A comparison of ISOLS and DASH scores before and after fibular head resorption, however, showed no deterioration in either score. CONCLUSIONS Long-term follow-up of humerus reconstruction by FVFHG showed no deterioration in upper limb function despite the risk of fibular head resorption. FVFHG of the proximal humerus is a reconstruction technique that can provide good long-term upper limb function.
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Affiliation(s)
- Soichi Ejiri
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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Tang X, Guo W, Yang R, Tang S, Ji T. Synthetic mesh improves shoulder function after intraarticular resection and prosthetic replacement of proximal humerus. Clin Orthop Relat Res 2015; 473:1464-71. [PMID: 25604875 PMCID: PMC4353552 DOI: 10.1007/s11999-015-4139-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/06/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder function often is limited after tumor resection and endoprosthetic replacement of the proximal humerus. This is partly attributable to the inability to reliably reattach rotator cuff tendons to the prosthesis and achieve adequate shoulder capsule repair with a metallic prosthesis. An option to attain these goals is to use synthetic mesh for the reconstruction, although the value of this method has not been well documented in the literature. QUESTIONS/PURPOSES We asked whether patients who had shoulder reconstruction using synthetic mesh had (1) better shoulder function; (2) improved ROM compared with shoulder reconstructions without mesh; and (3) more stable joints compared with those in patients with similar resections who had reconstructions without synthetic mesh. METHODS During a 5-year period, we performed 41 intraarticular resections with endoprosthetic reconstructions for malignancies in the proximal humerus meeting specified criteria to generate similarity in the study groups. Twelve patients (29%) were lost to followup before 24 months, leaving 29 patients available for review at a mean of 45 months (range, 24-70 months). This retrospective study compared 14 patients with soft tissue reconstruction that included synthetic mesh with 15 patients with soft tissue reconstruction without the use of synthetic mesh. The choice was made during consultation between the patient and surgeon, after reviewing the perceived advantages and disadvantages of each approach. A tumor band (ligament advanced reinforcement system) was used as synthetic mesh and wrapped around the prosthesis of the proximal humerus for soft tissue reconstruction in the reconstruction-with-mesh group. Study endpoints included the Musculoskeletal Tumor Society (MSTS) function scores, American Shoulder and Elbow Surgeons (ASES) score, shoulder ROM, and proximal migration of the humeral prosthesis. RESULTS The mean MSTS score for patients without synthetic mesh reconstruction was 20 ± 3 points (66%), whereas for patients with synthetic mesh reconstruction, the mean score was 24 ± 2 points (79%; p = 0.001). Patients with synthetic mesh reconstruction had a higher mean total ASES score (85 ± 1.1 points versus 72 ± 1.7 points; p = 0.025), and better function for activities of daily living. They also had better ROM on mean active forward flexion (p = 0.020), abduction (p < 0.001), and external rotation (p < 0.001) than patients without synthetic mesh reconstruction. Proximal migration of the prosthesis was observed in five of 15 of patients in the group without synthetic mesh reconstruction and in none of those treated with synthetic mesh (p = 0.042). CONCLUSIONS Patients with intraarticular resection and endoprosthetic replacement of the proximal humerus with reconstruction that included synthetic mesh had better shoulder function and ROM, and more stable joints than patients who had reconstruction without synthetic mesh. This result supports prior observations by others and it remains to be shown whether use of the ligament advanced reconstruction system is superior to other types of mesh or other types of reconstructions. Further investigation is needed but our results indicate that using mesh should be considered for patients with tumor resection and endoprosthetic replacement of the proximal humerus.
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Affiliation(s)
- Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044 China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044 China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044 China
| | - Shun Tang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044 China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, 100044 China
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Wafa H, Reddy K, Grimer R, Abudu A, Jeys L, Carter S, Tillman R. Does total humeral endoprosthetic replacement provide reliable reconstruction with preservation of a useful extremity? Clin Orthop Relat Res 2015; 473:917-25. [PMID: 24801261 PMCID: PMC4317414 DOI: 10.1007/s11999-014-3635-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy exists regarding the ideal method of reconstruction after proximal humeral resection and several reconstructive techniques have been reported. The reconstructive options are very limited when resection of the entire humerus is required. One option is endoprosthetic reconstruction, but there have been few published studies on the outcome of total humeral endoprosthetic reconstruction. QUESTIONS/PURPOSES The purposes of this study were (1) to assess the longevity of total humerus prostheses in those patients who survived their disease; (2) to review the complications associated with this prosthesis; and (3) to assess the Musculoskeletal Tumor Society functional score in survivors. METHODS Thirty-four patients (10 males, 24 females) with a mean age of 26 years (range, 7-86 years) were included in this study. Histological diagnosis was osteosarcoma in 15 patients, chondrosarcoma in seven, Ewing's sarcoma in seven, metastatic carcinoma in three, liposarcoma in one, and giant cell tumor of bone in one remaining patient. Twenty-nine patients had their total humeral endoprosthetic replacement for primary reconstruction, whereas the remaining five patients received their implants for failures with other reconstructive techniques. At a minimum followup of 3 months (mean, 8.2 years; range, 3 months to 29 years), 16 patients were alive with no evidence of disease, whereas 13 of the remaining 18 died with metastatic disease. Local recurrence was seen in five patients and all eventually died of disease progression. RESULTS According to the Kaplan-Meier survival analysis, the cumulative 10-year implant survival rate was 90%. Periprosthetic infection was seen in four patients, postoperative radial nerve palsy in one, and proximal migration of the prosthesis in three, whereas three patients needed a change of the articular elbow bushings at a mean of 16 years after the implant insertion. The mean Musculoskeletal Tumor Society functional score of the 28 patients who survived their disease for more than 12 months after the index procedure and could therefore be functionally assessed was 83% (range, 60%-93%). CONCLUSIONS From this small, preliminary report, we suggest that total humeral endoprosthetic replacement may be a reasonable option of reconstruction after tumor resection. We have shown that this prosthesis preserves the function of the hand. The local recurrence rate observed suggests that careful selection of patients is crucial. Infection was our most common surgical complication, but we showed that in those who survived their tumor, this prosthesis offers a method to preserve a functional upper extremity in some patients. Further study with more patients is necessary to confirm the value of this reconstruction method. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hazem Wafa
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Krishna Reddy
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Robert Grimer
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Lee Jeys
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Simon Carter
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
| | - Roger Tillman
- The Royal Orthopaedic Hospital Oncology Service, The Royal Orthopaedic Hospital NHS Trust, Bristol Road South, Birmingham, B31 2AP UK
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Outcome after reconstruction of the proximal humerus for tumor resection: a systematic review. Clin Orthop Relat Res 2014; 472:2245-53. [PMID: 24469551 PMCID: PMC4048415 DOI: 10.1007/s11999-014-3474-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tumors of the appendicular skeleton commonly affect the proximal humerus, but there is no consensus regarding the best reconstructive technique after proximal humerus resection for tumors of the shoulder. QUESTIONS/PURPOSES We wished to perform a systematic review to determine which surgical reconstruction offers the (1) best functional outcome as measured by the Musculoskeletal Tumor Society (MSTS) score, (2) longest construct survival, and (3) lowest complication rate after proximal humerus resection for malignant or aggressive benign tumors of the shoulder. METHODS We searched the literature up to June 1, 2013, from MEDLINE, EMBASE, and the Cochrane Library. Only studies reporting results in English, Dutch, or German and with followups of 80% or more of the patients at a minimum of 2 years were included. Twenty-nine studies with 693 patients met our criteria, seven studies (24%) were level of evidence III and the remainder were level IV. Studies reported on reconstruction with prostheses (n = 17), osteoarticular allografts (n = 10), and allograft-prosthesis composites (n = 11). Owing to substantial heterogeneity and bias, we narratively report our results. RESULTS Functional scores in prosthesis studies ranged from 61% to 77% (10 studies, 141 patients), from 50% to 78% (eight studies, 84 patients) in osteoarticular graft studies, and from 57% to 91% (10 studies, 141 patients) in allograft-prosthesis composite studies. Implant survival ranged from 0.38 to 1.0 in the prosthesis group (341 patients), 0.33 to 1.0 in the osteoarticular allograft group (143 patients), and 0.33 to 1.0 in allograft-prosthesis group (132 patients). Overall complications per patient varied between 0.045 and 0.85 in the prosthesis group, 0 and 1.5 in the osteoarticular graft group, and 0.19 and 0.79 in the prosthesis-composite graft group. We observed a higher fracture rate for osteoarticular allografts, but other specific complication rates were similar. CONCLUSIONS Owing to the limitations of our systematic review, we found that allograft-prosthesis composites and prostheses seem to have similar functional outcome and survival rates, and both seem to avoid fractures that are observed with osteoarticular allografts. Further collaboration in the field of surgical oncology, using randomized controlled trials, is required to establish the superiority of any particular treatment.
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Angelini A, Henderson E, Trovarelli G, Ruggieri P. Is there a role for knee arthrodesis with modular endoprostheses for tumor and revision of failed endoprostheses? Clin Orthop Relat Res 2013; 471:3326-35. [PMID: 23686427 PMCID: PMC3773157 DOI: 10.1007/s11999-013-3067-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/09/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them. QUESTIONS/PURPOSES Our objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap. METHODS We present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap. RESULTS Survivorship of arthrodeses with modular endoprostheses was 50% and 25% at 5 and 10 years, respectively. There were nine infections (29%) and one implant fracture (3%). Amputation as final surgery was required in 8 patients (six owing to infection and two to oncologic failures). There was no significant difference in survivorship between arthrodeses done for primary tumor resection and as a salvage procedure for failed implants. No differences were found between patients with and without prior infection or with and without a gastrocnemius flap. CONCLUSIONS Survivorship of a modular arthrodesis implant was 50% at 5 years owing to a high complication rate. Infection is the most common cause of failure of oncologic and revision implants. Implant fracture is a rare occurrence. Modular segmental arthrodesis provides a stable construct for patients in whom limb preservation is possible but a hinged device is contraindicated as a result of major muscle resection. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrea Angelini
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, BO Italy
| | - Eric Henderson
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, BO Italy
| | - Giulia Trovarelli
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, BO Italy
| | - Pietro Ruggieri
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, BO Italy
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Wieser K, Modaressi K, Seeli F, Fuchs B. Autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder after tumor resection. Arch Orthop Trauma Surg 2013; 133:1219-24. [PMID: 23793479 DOI: 10.1007/s00402-013-1795-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Arthrodesis of the shoulder is a straightforward and established alternative to reconstruct the shoulder function after tumor resection of the proximal humerus. In most cases, some kind of intercalary bone graft is used to bridge the bony defect. However, due to low stability of a single fibula autograft and disadvantages of exogenous graft material when performing combined allo- and autograft reconstruction, efforts to develop new surgical techniques, with the intention to lower the complication rates, are ongoing. MATERIALS AND METHODS We present a detailed description of the surgical technique and the outcome of three patients with osteosarcomas of the proximal humerus, which were treated with tumor resection and autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder. The construct was stabilized using a 4.5-mm pelvic reconstruction plate positioned on the scapular spine and the lateral aspect of the humerus. RESULTS A wide surgical margin was achieved in all patients. Two of them could be reintegrated and are able to work with excellent shoulder function. In one patient, who developed metastasis, a deep infection under chemotherapy 16 months after index surgery complicated the postoperative course. CONCLUSION The fibula's unique dual endosteal and periosteal blood supply makes it effective as a double-barrel bone graft for major long bone defects, which requires extra bone volume to prevent fractures until bone hypertrophy occurs. Additional bone and scar formation between the two struts are believed to provide a stable and long lasting construct, as seen in our patients.
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Affiliation(s)
- Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland.
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Kundu ZS, Gogna P, Gupta V, Kamboj P, Singla R, Sangwan SS. Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus. Strategies Trauma Limb Reconstr 2013; 8:149-54. [PMID: 23925868 PMCID: PMC3800512 DOI: 10.1007/s11751-013-0172-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 07/29/2013] [Indexed: 01/12/2023] Open
Abstract
Limb salvage surgery for malignant tumours of proximal humerus is an operative challenge, where the surgeon has to preserve elbow and hand functions and retain shoulder stability with as much function as possible. We treated 14 consecutive patients with primary malignant or isolated metastasis of proximal humerus with surgical resection and reconstruction by nail cement spacer. There were 8 females and 6 males, with a mean age of 28.92 years (range 16-51 years) and a mean follow-up of 30.14 months (range 12-52 months). The diagnosis was osteosarcoma in 8 patients, chondrosarcoma in 4 patients and metastasis from thyroid and breast carcinoma in 1 patient each. One of our patients had radial nerve neuropraxia, 1 developed inferior subluxation and 3 developed distant metastasis. Two patients died of disease and one developed local recurrence leading to forequarter amputation, leaving a total of 11 patients with functional extremities for assessment at the time of final follow-up which was done using the Musculoskeletal Tumour Society (MSTS) score. Though we were able to preserve the elbow, wrist and hand functions in all patients, the abductor mechanism, deltoid muscle and axillary nerve were not salvageable in any of cases. The mean MSTS score at the time of final follow-up was 19.09. Thus, proximal humeral reconstruction using nail cement spacer is a technical simple, cost-effective and reproducible procedure which makes it a reliable option in subset of patients where the functions around the shoulder cannot be preserved despite costlier prosthesis.
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Affiliation(s)
- Zile Singh Kundu
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
| | - Paritosh Gogna
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
| | - Vinay Gupta
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
| | - Pradeep Kamboj
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
| | - Rohit Singla
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
| | - Sukhbir Singh Sangwan
- Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J Medical Enclave, Rohtak, 124001 Haryana India
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Muramatsu K, Ihara K, Miyoshi T, Yoshida K, Iwanaga R, Hashimoto T, Taguchi T. Stimulation of neo-angiogenesis by combined use of irradiated and vascularized living bone graft for oncological reconstruction. Surg Oncol 2012; 21:223-9. [DOI: 10.1016/j.suronc.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/29/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
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Vascularized fibular graft for bone defects after wide resection of musculoskeletal tumors. J Orthop Sci 2012; 17:156-62. [PMID: 22382397 DOI: 10.1007/s00776-011-0194-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND In reconstruction by vascularized fibular graft (VFG) after wide resection of musculoskeletal tumors, there are problems such as the method of fixing the fibular graft, the period of achieving bone union, and the avoidance of postoperative fractures. We have performed VFG on 19 cases over a 30-year period. We have investigated these problems and now report the results. METHODS From 1980 to 2009, we performed VFG on 19 cases to reconstruct the bone defect after resection of a musculoskeletal tumor. The mean age was 19.5 years. Reconstructed bone defects were located in the femur in 10 cases (1 of inlay graft, 1 of individual intercalary graft, 7 of intercalary graft into treated bone, 1 of curettaged bone marrow), the tibia in 3 cases (1 of individual intercalary graft, 2 of intercalary graft into treated bone), the humerus in 3 cases (2 of sling procedure, 1 of individual intercalary graft), the foot in 2 cases individual intercalary graft, and the sacroiliac joint in 1 case of individual intercalary graft. The mean follow-up period after surgery was 7.25 years. We evaluated the success of primary bone union, the period required to achieve bone union, complications, clinical outcome, and the Musculoskeletal Tumor Society (MSTS) score. RESULTS Successful bone union was achieved for 79% of cases (15/19 patients). The average period required to achieve bone union was 7.8 months. There were 4 cases of non-union and 2 other complications. Clinical outcome status was continuous disease-free in 12 cases and died of disease in 7. The mean MSTS score was 98% (93-100%). CONCLUSION Vascularized fibular graft is a useful reconstructive procedure for long-bone defects after wide excision of musculoskeletal tumors. The method of fixation can be selected according to the situation; although times required for bone union are long, it is possible to prevent postoperative fractures by a combined approach with treated bone and/or double barrel fibular grafts.
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Yoshida Y, Tokuhashi Y. Total humerus replacement for osteosarcoma with proximal part of humerus: a case report. World J Surg Oncol 2012; 10:36. [PMID: 22333118 PMCID: PMC3311090 DOI: 10.1186/1477-7819-10-36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
Incisional biopsy and intramedullary pinning were performed for pathological fracture associated with a malignant bone tumor of the proximal humerus. Osteosarcoma, for which preoperative chemotherapy had been performed, was confirmed by postoperative pathological examination. To achieve wide resection and acquire a safe resected margin, total humerus replacement was performed, and the whole humerus was reconstructed using the Howmedica Modular Reconstruction system. The patient resumed normal activities, although mild contracture of the elbow joint remains 8 years after surgery.
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Affiliation(s)
- Yukihiro Yoshida
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610, Japan.
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Natarajan M, Sameer M, Kunal D, Balasubramanian N. Custom-made endoprosthetic total humerus reconstruction for musculoskeletal tumours. INTERNATIONAL ORTHOPAEDICS 2011; 36:125-9. [PMID: 21796334 DOI: 10.1007/s00264-011-1316-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 06/24/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE We analysed 11 patients with malignant musculoskeletal tumours of the humerus who underwent limb salvage surgery with total humeral custom endoprosthesis from 1990 to 2009. METHODS There were six male and five female patients, with a mean age of 17 years. The most common diagnosis was osteosarcoma. The average follow-up period was 66 months, with the maximum being 180 months. Functional and oncological outcomes were analysed. RESULTS The one and five year cumulative survival (Kaplan-Meier method) rates were 90.9% and 77.9 %. The average Musculoskeletal Tumour Society Score (MSTS) was 80%. Two patients died due to metastasis. One patient had a forequarter amputation for local recurrence. The procedure provides fast recovery and relatively good restoration of elbow function, whereas active shoulder movements remain limited CONCLUSION Total humeral custom endoprosthetic replacement represents a viable treatment option in indicated patients, providing reliable and reasonable function of the upper limb, with a low complication rate.
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Use of Vascularized Free Fibular Head Grafts for Upper Limb Oncologic Reconstruction. Plast Reconstr Surg 2011; 127:1244-1253. [DOI: 10.1097/prs.0b013e318205f34b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang J, Shen J, Dickinson IC. Functional outcome of arthrodesis with a vascularized fibular graft and a rotational latissimus dorsi flap after proximal humerus sarcoma resection. Ann Surg Oncol 2011; 18:1852-9. [PMID: 21331810 DOI: 10.1245/s10434-010-1443-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognosis of humeral sarcomas has improved greatly in the past 20 years. As a result, the challenges for orthopedic oncologists include long-term handicap and local morbidity. METHODS Shoulder reconstruction after the resection of sarcomas with the proximal humerus was evaluated for 55 patients from 1990 to 2007 at two universities. After S34(5)B resections (intra-articular resection of the proximal humerus and the abductor mechanism), the shoulders were reconstructed with arthrodesis, prosthesis, or allograft-prosthesis composites (APC). RESULTS At the time of the latest follow-up examination, the average duration of follow-up was 86.73 months for the 39 patients who were still alive and whose limbs were salvaged. The local recurrence rate was 7.27% (4 of 55). Functional evaluation was conducted on the 39 patients who had the postreconstructions: 12 arthrodeses, 17 prostheses, and 10 APC. Statistical analysis showed that the functional score of shoulder reconstruction significantly varied among the three groups by the test of homogeneity of variances with P = 0.222, by analysis of variance with P < 0.01, and by post hoc test (Student-Newman-Keuls) with α = 0.05. Primary arthrodesis resulted in better function and increased strength than the prostheses and the APC. Insertion of an allograft, a vascularized fibular graft, a rotational latissimus dorsi flap, and cancellous autograft bone were the preferred arthrodesis techniques used to achieve fusion and reduce complications. CONCLUSIONS After resection of the sarcoma with the proximal humerus with the abductor apparatus, shoulder arthrodesis is recommended above other reconstructions for better functional outcome as well as increased strength and capacity to position the hand.
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Affiliation(s)
- Jin Wang
- Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China.
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Yang Q, Li J, Yang Z, Li X, Li Z. Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results. INTERNATIONAL ORTHOPAEDICS 2010; 34:869-75. [PMID: 19701633 PMCID: PMC2989017 DOI: 10.1007/s00264-009-0857-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
Abstract
It is a great challenge to spare the upper limb with a malignant or invasive benign bone tumour of the shoulder girdle. We retrospectively analysed 35 patients with bone tumours of the shoulder girdle treated with various limb salvage procedures. The tumours included 25 primary malignancies, three metastases and seven giant cell tumours which involved the proximal humerus in 21 patients, scapula in 12 and clavicle in two. The reconstruction procedures included eight prosthetic replacements, four devitalised tumorous bone grafts, three osteoarticular allografts, two autogenous fibular grafts, one intramedullary cemented nail, three Tikhoff-Linberg procedures, two replantation of shortened arms, and four humeral head suspensions. Six partial scapulectomies and two lateral clavicectomies needed no bone reconstruction. With an average follow-up of 71 months, local recurrences occurred in four cases and systemic metastases in six. Nine patients died and 23 remained disease free. The five year Kaplan-Meier survival rate of 28 patients with malignancies was 69.5%. The average Musculoskeletal Tumour Society (MSTS) functional score was 77% (range 40-100%) in all patients.
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Affiliation(s)
- Qiang Yang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Jianmin Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Zhiping Yang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Xin Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
| | - Zhenfeng Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 People’s Republic of China
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Raiss P, Kinkel S, Sauter U, Bruckner T, Lehner B. Replacement of the proximal humerus with MUTARS tumor endoprostheses. Eur J Surg Oncol 2010; 36:371-7. [DOI: 10.1016/j.ejso.2009.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 10/20/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022] Open
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Muramatsu K, Fukano R, Ihara K, Iwanaga R, Taguchi T. Reconstruction of the proximal humerus by combined use of extracorporeally-irradiated osteochondral graft and free vascularized fibula following resection of Ewing sarcoma. J Plast Reconstr Aesthet Surg 2010; 63:2177-80. [PMID: 20347410 DOI: 10.1016/j.bjps.2010.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/13/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022]
Abstract
Reconstruction of the proximal humerus following limb-saving resection of malignant bone tumor is extremely challenging. We describe here a novel anatomical reconstruction technique in a young patient. A 6-year-old girl with Ewing sarcoma of the proximal humerus was treated by wide excision of the tumor followed by reconstruction with extracorporeally-irradiated osteoarticular autograft combined with an intramedullary inserted free vascularized fibula graft. Proper alignment of the shoulder joint was maintained with no osteoarthritic changes after 16 months. The resulting limb function was satisfactory. This biological reconstruction method was safe and without serious complication. It is indicated for the reconstruction of non-weight-bearing joints and is ideal for the proximal humerus.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Abstract
OBJECTIVE To study the applied anatomy of the vascular and muscular innervations related to vascularized fibular grafts. METHODS Thirty-four cadaveric lower extremities were dissected for this study. The observations included fibular length, fibular nutrient artery, arcuate arteries, and innervation of fibular muscles. The fibulas were averagely divided into four segments and the locations of relevant vessels and nerves were ascertained. RESULTS All specimens had 1 fibular nutrient artery and 4-9 arcuate arteries except 1 specimen which had only 1 arcuate artery. The fibular nutrient artery and the first three arcuate arteries were constantly located between the distal half of the 1/4 segment and 2/4 segment of the fibula. The muscular branch of the superficial peroneal nerve passed through the surface of the periosteum in the 2/4 segment of the fibula. CONCLUSIONS The most proximal osteotomy point locates at the midpoint of the 1/4 segment by which it ensure the maximal potential for preserving the nutrient vessels. The muscular branch of the superficial peroneal nerve is fragile to injury at the 2/4 segment of the fibula.
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Affiliation(s)
- Yue-liang Zhu
- Orthopedic Department, Kunming General Hospital, Chengdu Military Command, Kunming 650032, China.
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31
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Abstract
PURPOSE To review and compare the postoperative outcomes of 3 types of shoulder reconstructions: prosthetic arthroplasty, clavicula pro humero reconstruction, and allograft arthrodesis. METHODS Records of 25 shoulder reconstructions following tumour resection were retrospectively reviewed. Perioperative data, oncological prognoses, postoperative complications, and functions were assessed. RESULTS We performed 10 prosthetic arthroplasties, 7 clavicula pro humero procedures, 4 allograft arthrodeses, and 4 soft tissue reconstructions. Eight patients died of their diseases. Three developed complications and underwent revision surgery. 19 patients achieved stable shoulders. Ten patients attended for functional assessments. Respective mean scores using the Musculoskeletal Tumor Society-International Symposium on Limb Salvage and the Toronto Extremity Salvage Score were: 77% and 82% for prosthetic arthroplasties, 67% and 62% for clavicula pro humero procedures, 83% and 70% for allograft arthrodeses, and 93% and 98% for soft tissue reconstructions. CONCLUSION A stable construct is the treatment goal for shoulder reconstructions, as it enables effective function of the arm and hand.
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Affiliation(s)
- Y Kitagawa
- Department of Surgery, University of Melbourne, Victoria, Australia
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32
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Mourikis A, Mankin HJ, Hornicek FJ, Raskin KA. Treatment of proximal humeral chondrosarcoma with resection and allograft. J Shoulder Elbow Surg 2007; 16:519-24. [PMID: 17521925 DOI: 10.1016/j.jse.2006.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 09/13/2006] [Accepted: 10/22/2006] [Indexed: 02/01/2023]
Abstract
Chondrosarcoma of the proximal humerus is an uncommon malignant bone tumor, and limited information is available about treatment. We retrospectively reviewed 31 patients treated by resection and replacement with allograft implants during the past 24 years. The patients were followed up for an average of more than 16 years. Despite some allograft complications, the overall success rate for the grafts was 77%, and patient survival was 96%. Only 1 patient died. Two patients required amputation for local recurrences, and the remainder did reasonably well despite some functional problems. On the basis of this study and by comparison data, we believe that proximal humeral chondrosarcomas are less malignant than chondrosarcomas in other sites. In comparing them against 26 metallic implants, we believe that resection and allograft implantation remains a generally successful treatment, although the improvement of the metallic devices over the years has made this technique more available and acceptable.
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Affiliation(s)
- Anastasios Mourikis
- Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA
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33
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Kiss J, Sztrinkai G, Antal I, Kiss J, Szendroi M. Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elbow Surg 2007; 16:273-9. [PMID: 17321167 DOI: 10.1016/j.jse.2006.08.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 07/28/2006] [Accepted: 08/09/2006] [Indexed: 02/01/2023]
Abstract
From 1981 to 2001, 91 shoulder resections were performed to treat shoulder girdle tumors (64 primary and 27 metastatic) in 90 patients (53 male and 37 female patients). The mean age was 34 years in patients with a primary tumor and 61 years in those with metastases. There were 7 partial scapulectomies, 13 total scapulectomies, 56 proximal humeral resections, 5 diaphyseal resections, 5 total shoulder girdle resections (Tikhoff-Linberg procedure), and 5 other procedures performed. Prosthesis implantation was carried out in 41 cases, autologous fibular transposition was done in 19, and massive homologous bone grafting was done in 4. Of the patients, 37 were clinically reviewed with a mean follow-up of 4.7 years (range, 1-20 years) by use of the recommendations of the Musculoskeletal Tumor Society for pain, function, position of hand, lifting ability, manual dexterity, and satisfaction. Nine patients were reviewed via a questionnaire and telephone interview. Twenty-six had died, and eighteen were lost to follow-up. The best results were achieved after partial scapulectomy and after humeral resection reconstructed with fibular transposition, when the function of the rotator cuff was preserved. After total scapulectomy and after humeral resection with the implantation of a tumor endoprosthesis, the function of the shoulder remained moderate because the rotator cuff was damaged. The overall satisfaction was generally good after all types of shoulder resections as a result of pain relief, preserved hand function, and improvement of psychological status. Patients can compensate extremely well by using the preserved joints and the contralateral upper limb; therefore, patient satisfaction does not rely on shoulder function alone.
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Affiliation(s)
- János Kiss
- Department of Orthopaedics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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34
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Gebert C, Hillmann A, Schwappach A, Hoffmann C, Hardes J, Kleinheinz J, Gosheger G. Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity. J Surg Oncol 2006; 94:114-27. [PMID: 16847920 DOI: 10.1002/jso.20326] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Limb salvage is viable in the majority of patients with malignant bone tumors, but especially in case of extensive tumors and bad soft tissue conditions, it is challenging in upper extremity. OBJECTIVES/METHOD The clinical and radiological results of 21 patients, who had free vascularized fibular grafts (VFG), for diaphyseal (14), and epipyseal (7) defect reconstruction of the upper extremity, are presented. The indications for VFG were resection after osteosarcoma (9 cases), Ewings sarcoma (9 cases), chondrosarcoma (1 case), rhabdomyosarcoma (1 case), and 1 case of fibrous dysplasia. The 20 malignant tumors were staged as follows: 2a (1), 2b (18), 3 (1). The mean follow-up was 43.6 months (min 6.0-max 131.9). Functional results were described and graded quantitatively according to the MSTS-score. RESULTS Results were satisfactory with regard to pain, emotional acceptance, manual dexterity, and function. Lifting ability was decreased in two patients. Hypertrophy index was 31% (min 13%-max 71%). Main complications were fracture (5), pseudoarthrosis (4), prolonged wound healing (4), temporary nerve irritation (2), and deep infection (1). Re-operation was required in eight patients (12 operations). CONCLUSION VFG offers a good possibility for biological reconstruction of large skeletal defects, with an acceptable complication and re-operation rate. When conservative treatment of complications was not successful, further surgery led to recovery in the majority of cases.
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Affiliation(s)
- C Gebert
- Department of Orthopaedics, Westfaelische Wilhelms-Universitaet Muenster, Albert-Schweitzer-Strasse, Muenster, Germany.
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Mayilvahanan N, Paraskumar M, Sivaseelam A, Natarajan S. Custom mega-prosthetic replacement for proximal humeral tumours. INTERNATIONAL ORTHOPAEDICS 2006; 30:158-62. [PMID: 16565840 PMCID: PMC2532098 DOI: 10.1007/s00264-005-0029-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 08/29/2005] [Accepted: 09/26/2005] [Indexed: 10/24/2022]
Abstract
We used custom mega-prostheses in 57 patients with aggressive benign and malignant tumours of the proximal humerus. The most common tumour was osteosarcoma, followed by giant cell tumour and chondrosarcoma. We achieved extra-articular and wide resection margins in all primary malignant tumours and narrow margins in benign and metastatic tumours. Six patients died of disease, 4 patients developed local recurrences and 43 were continuously disease free at an average follow-up of 5.5 years (range 2-14.5 years). Five patients required revision replacements. The most common complications were proximal subluxation and aseptic loosening. Functional outcome was satisfactory in 78% of cases.
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Affiliation(s)
- N Mayilvahanan
- Department of Orthopaedics & Traumatology, Madras Medical College & Research Institute, Government General Hospital, Chennai 600 003, India.
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36
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Viehweger E, Gonzalez JF, Launay F, Legre R, Jouve JL, Bollini G. [Shoulder arthrodesis with vascularized fibular graft after tumor resection of the proximal humerus]. ACTA ACUST UNITED AC 2005; 91:523-9. [PMID: 16327688 DOI: 10.1016/s0035-1040(05)84442-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF THE STUDY Resection of malignant tumors of the proximal humerus often requires dissection of the rotator cuffs and the deltoid muscle. There is no consensus on the ideal method for shoulder reconstruction. We report the functional outcome in a homogeneous series of eight patients treated by arthrodesis using a vascularized free fibular flap. MATERIAL AND METHODS Eight patients were included in this study. All had an aggressive tumor of the upper humerus. Tumor resection was associated with a rotator cuff and deltoid muscle resection in all patients. All patients then underwent shoulder arthrodesis using a free vascularized fibular flap fixed with a plate. Clinical and radiological evaluation was available for six patients at mean 28 months. The Musculoskeletal Tumor Society function score was used to assess overall function of the upper limb. The cosmetic outcome and radiographic bone healing as well as hypertrophy of the fibular graft were noted. RESULTS Active abduction and active flexion were 82 degrees on average. All patients could bring their hand to the mouth. Circumduction was possible but limited in amplitude. The mean function score was 26.5/30 with an excellent functional outcome in all patients. The cosmetic outcome was considered poor by all patients. Radiographically, bone healing was achieved at last follow-up in all patients but there was one case of failed fusion between the fibular graft and the scapula which required secondary iliac grafting. Mean fibular graft hypertrophy was 32.8% at last follow-up. DISCUSSION AND CONCLUSION Two reconstruction methods have been described for patients who require tumor resection of the upper humerus: reconstruction with preservation of glenohumeral joint function and shoulder arthrodesis. Many techniques have been described for each method. It is however difficult to compare the different series reported in the literature because rotator cuff and deltoid muscle resection was not systematically performed and reconstruction methods varied between patients. An analysis of the literature shows that preservation of motion of the scapular glenoid joint can give good functional results when the rotator cuff and deltoid muscle can be preserved. If they cannot, results favor shoulder arthrodesis which provides the patient with very satisfactory upper limb function. Use of a vascularized fibular flap has provided very good arthrodesis results. The patient must however be informed of the probable poor final cosmetic result.
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Affiliation(s)
- E Viehweger
- Service de Chirurgie Orthopédique, Hôpital Timone-Enfants, Marseille
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37
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De Wilde L, Plasschaert F. Prosthetic treatment and functional recovery of the shoulder after tumor resection 10 years ago: a case report. J Shoulder Elbow Surg 2005; 14:645-9. [PMID: 16337535 DOI: 10.1016/j.jse.2004.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 11/07/2004] [Indexed: 02/01/2023]
Affiliation(s)
- Lieven De Wilde
- Department of Orthopaedics Surgery, Physical Medicine and Rehabilitation, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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38
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Erdmann D, Giessler GA, Bergquist GEO, Bruno W, Young H, Heitmann C, Levin LS. [Free fibula transfer. Analysis of 76 consecutive microsurgical procedures and review of the literature]. Chirurg 2004; 75:799-809. [PMID: 15138656 DOI: 10.1007/s00104-004-0833-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.
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Affiliation(s)
- D Erdmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Manfrini M, Vanel D, De Paolis M, Malaguti C, Innocenti M, Ceruso M, Capanna R, Mercuri M. Imaging of vascularized fibula autograft placed inside a massive allograft in reconstruction of lower limb bone tumors. AJR Am J Roentgenol 2004; 182:963-70. [PMID: 15039172 DOI: 10.2214/ajr.182.4.1820963] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Bone allografts and vascularized fibula autografts were combined (the fibula inside the massive allograft) for skeletal reconstruction in a homogeneous group of patients. To verify the biologic behavior of the grafts, we followed the series using conventional radiography and CT analysis. MATERIALS AND METHODS Twenty-four patients with bone tumors had intercalary segments of tibia or femur reconstructed and were followed up for 36-120 months. Sequential radiographs and CT scans were analyzed. RESULTS Three types of behavior were observed. In 13 patients, the allograft maintained its architecture without fracture, although a regular enlargement of the inlaid fibula led to progressive integration with the allograft. A dense line on allograft endosteum was the first sign of bone bridges heralding fusion of the two grafts. In eight patients, fracture or nonunion of the allograft occurred, and the autograft reacted with rapid appearance of dense hypertrophy that again induced bridges to the allograft. In three patients, no changes in autograft size and density were followed by fracture with no callus formation. This behavior was interpreted as unsuccessful vascularization of the autograft. CONCLUSION Sequential radiography and CT analysis enabled us to understand the changes in a combined graft offering an original way to revascularize bone allografts.
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Affiliation(s)
- Marco Manfrini
- Dipartimento di Oncologia Muscolo-Scheletrica, Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna 40136, Italy.
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40
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Ihara K, Shigetomi M, Muramatsu K, Katsube K, Kaneko N, Goto Y, Kawai S. Pedicle or free musculocutaneous flaps for shoulder defects after oncological resection. Ann Plast Surg 2003; 50:361-6. [PMID: 12671376 DOI: 10.1097/01.sap.0000041245.97401.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Management of soft-tissue defects of the shoulder is described. Extensive defects of soft tissues with or without overlying skin were created after resection of sarcomas in five patients. Reconstruction was performed using musculocutaneous flaps, which included three pedicle latissimus dorsi and two free tensor fascia lata flaps. Simultaneous functioning replacement of the defects of the trapezius and deltoid muscles were each achieved in two patients. Primary wound healing was achieved, and each patient recovered good contour of the shoulder. Functional results were satisfactory in all patients with an average score of 93.4% (range, 83%-100%) using the system of the Musculoskeletal Tumor Society. The four functioning muscles recovered active contraction in the transferred position. The shoulder elevation was normal in three patients, and was 90 degrees and 30 degrees in one patient each. All patients remained disease-free at the time of latest follow-up. Thus, shoulder defects of the soft tissues can be managed appropriately with the two representative musculocutaneous flaps.
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Affiliation(s)
- Koichiro Ihara
- Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
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