Allograft-Prosthesis Composite Reconstruction of the Proximal Part of the Humerus: Functional Outcome and Survivorship

Abdeen, Ayesha; Hoang, Bang H.; Athanasian, Edward A.; Morris, Carol D.; Boland, Patrick J.; Healey, John H.
October 2009
Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2406
Academic Journal
Background: Limb salvage following resection of a tumor in the proximal part of the humerus poses many challenges. Reconstructive options are limited because of the loss of periarticular soft-tissue stabilizers of the glenohumeral joint in addition to the loss of bone and articular cartilage. The purpose of this study was to evaluate the functional outcome and survival of the reconstruction following use of a humeral allograft-prosthesis composite for limb salvage. Methods: An allograft-prosthesis composite was used to reconstruct a proximal humeral defect following tumor resection in thirty-six consecutive patients at one institution over a sixteen-year period. The reconstruction was performed at the time of a primary tumor resection in thirty cases, after a failure of a reconstruction following a previous tumor resection in five patients, and following excision of a local recurrence in one patient. The mean duration of follow-up of the living patients was five years. Glenohumeral stability, function, implant survival, fracture rate, and union rate following the reconstructions were measured. Functional outcome and implant survival were analyzed on the basis of the amount of deltoid resection, whether the glenohumeral resection had been extra-articular or intra-articular, and the length of the humerus that had been resected. Results: One patient sustained a glenohumeral dislocation. Deltoid resection (partial or complete) resulted in a reduced postoperative range of motion in flexion and abduction but had no effect on the mean Musculoskeletal Tumor Society score. Extra-articular resections were associated with lower Musculoskeletal Tumor Society scores. All patients had either mild or no pain and normal hand function at the time of final follow-up. The overall estimated rate of survival of the construct, with revision as the end point, was 88% at ten years. There were three failures due to progressive prosthetic loosening that necessitated removal of the construct. Four patients required an additional bone-grafting procedure to treat a delayed union of the osteosynthesis site. Conclusions: An allograft-prosthesis composite used for limb salvage following tumor resection in the proximal part of the humerus is a durable construct associated with an acceptable complication rate. Deltoid preservation and intraarticular resection are associated with a greater range of shoulder motion and a superior functional outcome, respectively. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Transosseous Suture Fixation of Proximal Humeral Fractures. Dimakopoulos, Panayiotis; Panagopoulos, Andreas; Kasimatis, Georgios // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p8 

    BACKGROUND: The optimal treatment of displaced fractures of the proximal part of the humerus remains controversial. We evaluated the long-term functional and radiographic results of transosseous suture fixation in a series of selected displaced fractures of the proximal part of the humerus....

  • PERSPECTIVE. Barber, F. Alan // Orthopedics Today;Jul2011, Vol. 31 Issue 7, p55 

    The author presents his views on Daniel Hampton's study which investigated the influence of donor age on clinical outcomes in cases of anterior cruciate ligament (ACL) reconstruction with patellar tendon allograft.

  • Osteochondral allograft reconstruction of segmental defect of humeral head after posterior dislocation of the shoulder. Barbier, Olivier; Bajard, Xavier; Bouchard, Antoine; Ollat, Didier; Marchaland, Jean; Nguyen, Lan; Versier, Gilbert // European Journal of Orthopaedic Surgery & Traumatology;Oct2010, Vol. 20 Issue 7, p581 

    Introduction: Posterior shoulder dislocations are rare and almost 50% are associated with fractures of the humeral head. Although, there are only few articles describing specific treatments for the humeral head defects. Case report: In this paper, authors described a typical case of a...

  • Fibula and tibia fusion with cancellous allograft vitalised with autologous bone marrow: first results for infected tibial non-union. Ateschrang, Atesch; Ochs, Björn; Lüdemann, Martin; Weise, Kuno; Albrecht, Dirk // Archives of Orthopaedic & Trauma Surgery;Jan2009, Vol. 129 Issue 1, p97 

    Autogenous bone grafting has been used in reconstructing bone defects and in stimulating fracture healing, producing high healing rates in the treatment of infected tibial non-unions. A novel therapeutic alternative is now available known as “vitalised allograft”, a cancellous bone...

  • Autogenous non-vascularized fibula for treatment of giant cell tumor of distal end radius. Chadha, Manish; Arora, Shobha; Singh, Arun; Gulati, Divesh; Singh, Ajay // Archives of Orthopaedic & Trauma Surgery;Dec2010, Vol. 130 Issue 12, p1467 

    Introduction: Giant cell tumor of distal end of radius is treated by wide resection and intralesional procedures with former having better results. The various modalities for the defect created are vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We...

  • Analysis of Plasma Flame-Sprayed Coatings on Endosseous Oral Titanium Implants Exfoliated in Man: Preliminary Results. Lüthy, H.; Strub, J. R.; Schärer, P. // International Journal of Oral & Maxillofacial Implants;Winter1987, Vol. 2 Issue 4, p62 

    The plasma flame-sprayed coatings on seven ITI-Hollow Basket Implants (types E, F, and K) and eight IMZ-Implants (Cylinder and Cylinder Extension), exfoliated in man, were analyzed metallographically and compared with nonused implants of the same types. Two thirds of the retrieved implants...

  • Revision of failed humeral head resurfacing arthroplasty. Streubel, Philipp N.; Simone, Juan P.; Cofield, Robert H.; Sperling, John W. // International Journal of Shoulder Surgery;Jan-Mar2016, Vol. 10 Issue 1, p21 

    Purpose: The purpose of this study is to assess the outcomes of a consecutive series of patients who underwent revision surgery after humeral head resurfacing (HHR). Our joint registry was queried for all patients who underwent revision arthroplasty for failed HHR at our institution from 2005 to...

  • Contemplating a Bone Graft. Marseus, Wayne; Hull, Larry D.; Meislin, Rob // Running & FitNews;Mar/Apr2008, Vol. 26 Issue 2, p13 

    The article reports on a case of a 52-year-old, who has been a runner for 22 years but who can no longer run on pavements after being diagnosed with osteochondritis dissecans (OCD). It notes that in OCD, which usually affects knees and elbows, a loose piece of bone and cartilage separates from...

  • Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF. Schnetzke, Marc; Aytac, Sara; Deuss, Moritz; Studier-Fischer, Stefan; Swartman, Benedict; Muenzberg, Matthias; Gruetzner, Paul-Alfred; Guehring, Thorsten // International Orthopaedics;Nov2014, Vol. 38 Issue 11, p2295 

    Purpose: Elbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics