Outcomes of modular endoprosthesis reconstruction versus cement spacer reconstruction following resection of proximal humeral tumors

Abstract

Background There is no agreement about the best reconstructive option following resection of proximal humerus tumors. The purpose of this study was to compare the functional outcomes of endoprosthesis reconstruction versus nail cement spacer reconstruction after wide resection of proximal humeral tumors. Methods This retrospective comparative study included 58 patients with proximal humerus tumors who had undergone tumor resection and reconstruction with modular endoprosthesis (humeral hemiarthroplasties) or cement spacer. Medical records were reviewed for the epidemiological, clinical, radiological, and operative data. Lung metastasis, local recurrence, and complication were also reviewed. The functional outcome was evaluated using the Musculoskeletal Tumor Society scoring (MSTS) system. Results Nineteen patients with a mean age of 33.4 ± 17.5 years underwent reconstruction by modular endoprosthesis, and 39 patients with a mean age of 24.6 ± 14.3 years underwent reconstruction by cement spacer. The mean MSTS score was 24.8 ± 1.1 in the endoprosthesis group and 23.9 ± 1.4 in the spacer group, P = 0.018. Complications were reported in 5 (26.3%) patients in the endoprosthesis group and 11 (28.2%) patients in the spacer group, P = 0.879. There were no statistically significant differences in the functional outcomes in both patient groups with or without axillary or deltoid resection. Conclusions Both endoprostheses and cement spacers are durable reconstructions with almost equal functional outcomes with no added advantage of the expensive endoprosthesis.

Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases

“…They have demonstrated in vitro how the presence of Trevira fibers around the oncological megaprosthesis gives a better anatomical reinsertion of soft tissues due to the extension of new cells (94% of them were vital cells) and their adhesion pattern [ 26 ]. Another hypothesis could be the average age of our patients (61.3 ± 13.26 years), compared with the Ebeid et al study (33.4 ± 17.5 years), who, therefore, being older and requiring less functionality than a young adult, report a better functional outcome [ 25 ].…”

“…In their study, Ebeid et al reported patients with primary or metastatic tumors of the proximal humerus who underwent reconstructive surgery with modular proximal humerus endoprosthesis, with a mean MSTS score of 24.8 ± 1.1. In this study, this group was compared with a nail-cemented spacer reconstruction which had a mean MSTS score of 23.9 ± 1.4 [ 25 ]. In our study, patients had a mean MSTS score of 57.6% and therefore had a better functional outcome; this could be due to the use (in all surgeries) of the Trevira tube compared to the Ethibond and FiberWire sutures that Ebeid et al used in some cases [ 25 ].…”

“…In this study, this group was compared with a nail-cemented spacer reconstruction which had a mean MSTS score of 23.9 ± 1.4 [ 25 ]. In our study, patients had a mean MSTS score of 57.6% and therefore had a better functional outcome; this could be due to the use (in all surgeries) of the Trevira tube compared to the Ethibond and FiberWire sutures that Ebeid et al used in some cases [ 25 ]. To support this hypothesis, we can take into account the D’Adamio et al in vitro study regarding the soft tissue adhesion patterns over Trevira on modular endoprosthesis [ 26 ].…”

“…In the endoprosthesis group, Ebeid et al obtained a mean MSTS score of 24.8 ± 1.1, while it was 23.9 ± 1.4 in the spacer group, p = 0.018. These results probably depend on a selection bias as the endoprosthesis was carried out in smaller tumors with lesser muscle resection and in patients with preserved axillary nerves [ 25 ]. In accordance with our results, a larger resection could therefore influence functional outcomes.…”

Reconstruction Strategy for Upper Extremity Defects After Bone Tumor Resection Based on 3D Customized Bone Cement Mold

“…To the best of our knowledge, only a few authors have reported this method, but it has shown comparable functional outcomes in upper extremities. [30][31][32] However, the majority of bone cement prostheses or nail cement spacers reported in literature are manually fabricated intraoperatively. Kneading bone cement into an epiphyseal shape is a time-consuming process that can result in inaccurate shapes.…”