Rodolfo Capanna1, Francesco Muratori1, Francesco R Campo2, Antonio D'Arienzo3, Filippo Frenos1, Giovanni Beltrami1, Guido Scoccianti1, Pierluigi Cuomo1, Andrea Piccioli4, Daniel A Müller5. 1. Department of Orthopaedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 2. Department of Orthopaedic and Traumatology, University of Messina, Italy. 3. Department of Orthopaedic and Traumatology, University of Palermo, Italy. 4. Oncologic Centre "Palazzo Baleani", Azienda Policlinico Umberto I, Rome, Italy. 5. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Switzerland. Electronic address: daniel.mueller@balgrist.ch.
Abstract
BACKGROUND: Reconstruction of large bone defects around the elbow joint is surgically demanding due to sparse soft tissue coverage, complex biomechanics and the close proximity to neurovascular structures. Modular megaprostheses are established reconstruction tools for the elbow, but only small case series have been reported in the literature. METHODS: Thirty-six patients who underwent reconstruction of the elbow joint with a modular megaprosthesis were reviewed retrospectively. In 31 patients (86.1%), elbow replacement was performed after resection of a bone tumour, whereas five non-oncological patients (13.9%) underwent surgery because of a previous failed elbow reconstruction. Functional outcome, rate of complications and oncological results were considered as primary endpoints. RESULTS: The mean follow-up was 25 months. The average achieved Mayo Elbow Performance Score (MEPS) was 77.08 (range 40-95) and the average Musculoskeletal Tumor Society (MSTS) score was 22.9 (range 8-30). Six complications (16.7%) were observed: two radial palsies, one temporary radial nerve dysfunction, one ulnar palsy, one disassembling of the articular prosthesis component and one deep infection necessitating the only implant removal. The overall 5-year survival rate of the patients was poor (25.1%) because of rapid systemic progression of the oncological disease in patients with metastatic lesion. However, the 5-year survival rate of the implant was very satisfactory (93%). CONCLUSIONS: Modular megaprosthesis is a reliable and effective reconstruction tool in large bone defects around the elbow joint. The complication rates are lower than seen in osteoarticular allografts and allograft-prosthesis composites while the functional outcome is equal. In palliative situations with metastatic disease involving the elbow, modular megaprosthesis enables rapid recovery and pain relief and preserves elbow function.
BACKGROUND: Reconstruction of large bone defects around the elbow joint is surgically demanding due to sparse soft tissue coverage, complex biomechanics and the close proximity to neurovascular structures. Modular megaprostheses are established reconstruction tools for the elbow, but only small case series have been reported in the literature. METHODS: Thirty-six patients who underwent reconstruction of the elbow joint with a modular megaprosthesis were reviewed retrospectively. In 31 patients (86.1%), elbow replacement was performed after resection of a bone tumour, whereas five non-oncological patients (13.9%) underwent surgery because of a previous failed elbow reconstruction. Functional outcome, rate of complications and oncological results were considered as primary endpoints. RESULTS: The mean follow-up was 25 months. The average achieved Mayo Elbow Performance Score (MEPS) was 77.08 (range 40-95) and the average Musculoskeletal Tumor Society (MSTS) score was 22.9 (range 8-30). Six complications (16.7%) were observed: two radial palsies, one temporary radial nerve dysfunction, one ulnar palsy, one disassembling of the articular prosthesis component and one deep infection necessitating the only implant removal. The overall 5-year survival rate of the patients was poor (25.1%) because of rapid systemic progression of the oncological disease in patients with metastatic lesion. However, the 5-year survival rate of the implant was very satisfactory (93%). CONCLUSIONS: Modular megaprosthesis is a reliable and effective reconstruction tool in large bone defects around the elbow joint. The complication rates are lower than seen in osteoarticular allografts and allograft-prosthesis composites while the functional outcome is equal. In palliative situations with metastatic disease involving the elbow, modular megaprosthesis enables rapid recovery and pain relief and preserves elbow function.
Authors: Gopikanthan Manoharan; Robert W Jordan; Georgios Orfanos; Manikandar S Cheruvu; Paul Cool; Stuart M Hay Journal: Shoulder Elbow Date: 2021-05-20
Authors: Pramod Kamalapathy; Akash Shah; Kevin Raskin; Joseph H Schwab; Santiago A Lozano-Calderón Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2021-02-11
Authors: Christoph Theil; Jan Schwarze; Georg Gosheger; Burkhard Moellenbeck; Kristian Nikolaus Schneider; Niklas Deventer; Sebastian Klingebiel; George Grammatopoulos; Friedrich Boettner; Tom Schmidt-Braekling Journal: Cancers (Basel) Date: 2022-01-11 Impact factor: 6.639