PROSTHETIC RECONSTRUCTION OF THE HUMERUS AFTER RESECTION OF PRIMARY TUMORS:EXPERIENCE OF THE ISTITUTO RIZZOLI IN 277 CASES

Abstract

Purpose of this study was to analyse the different techniques of prosthetic reconstruction of the humerus (also in association with bone grafts) after resection of primary tumors, discussing indications and evaluating implant survival.

Material and Methods: Between 1974 and 2006, 277 patients had prosthetic reconstruction of the humerus after tumor resection. These included 253 reconstructions of the proximal humerus: 225 cemented modular prostheses (MRS), 18 uncemented modular prostheses, 9 allograft/prostheses composites, 1 custom-made prosthesis; 2 diaphyseal reconstructions:1 intercalary prosthesis and 1 MRS; 13 reconstructions of the distal humerus: 11 uncemented modular prostheses, 1 allograft/prosthesis, 1 Coonrad-Morrey prosthesis; 9 total humerus reconstructions: 6 uncemented modular prostheses, 2 allograft/prostheses composites, 1 custom made prosthesis. The uncemented modular prosthesis used was the HMRS^® and the cemented modular was the MRS^®.

Histologically 24 were benign tumors and 253 primary malignant tumors.

All patients were periodically followed in the clinic, imaging studies and histology were reviewed and special attention given to prostheses-related complications and implant survival.

Univariate analysis through actuarial Kaplan Meier curves was used in evaluating implant survival to major complications. Functional results were assessed using the MSTS system.

Results: at a medium follow-up of 9 years 121 patients were NED, 14 NED1pm, 7 NED1lr, 1 NED1bm, 3 NED2pm, 2 NED2lr, 1 NED3pm, 102 died of disease, 19 died of other disease, 7 were lost to follow-up.

Major complications of the implants included 19 cases of deep infection (6.8%), 8 aseptic loosenings (2.9%), 4 breakages (1.4%) causing failure of the implants requiring revisions. Further complications were observed in revised cases. Actuarial curve of implant survival to major complications showed over 80% at 10 years and over 70% at 20 years.

Functional results according to the MSTS system were good or excellent (over 50%) in more than 90% of the patients, with an average score of 79%.

Conclusion: different techniques are available in reconstructions of the humerus after tumor resection, the indications depending on the type of resection and removal of soft tissues required.