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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 11, 1498-1503.
doi: 10.1302/0301-620X.89B11.19577  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Endoprosthetic replacement of the distal humerus following resection of bone tumours

S. A. Hanna, MRCS, Clinical Research Fellow1; L. A. David, FRCS(Orth), Specialist Registrar1; W. J. S. Aston, FRCS(Orth), Specialist Registrar1; P. D. Gikas, MRCS, Research Fellow1; G. W. Blunn, PhD, Professor of Biomedical Engineering2; S. R. Cannon, FRCS&MCh(Orth), Consultant Orthopaedic Surgeon1; and T. W. R. Briggs, FRCS&MCh(Orth), Consultant Orthopaedic Surgeon1

1 London Bone & Soft Tissue Tumour Service
2 Institute of Orthopaedics and Musculoskeletal Science Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.

Correspondence should be sent to Mr S. A. Hanna; e-mail: sammyhanna{at}hotmail.com

Between 1988 and 2006, 18 patients had a custom-made endoprosthetic replacement of the distal humerus for bone tumours at our institution. There were 11 primary malignant neoplasms, six secondary deposits, and one benign aggressive tumour. The mean follow-up was for 4.4 years (1 to 18.2). Complications occurred in nine patients and included aseptic loosening in three (16.6%), local recurrence in two (11%), infection in two (11%), neuropraxia of the radial nerve in one (5.5%) and a peri-prosthetic fracture in one (5.5%). Excision was inadequate in four patients (22%), all of which developed local recurrence and/or metastases. There were seven deaths from the primary disease after a mean of 2.3 years (1 to 5), one of whom had an above-elbow amputation for local recurrence seven months before death. The remaining six had satisfactory elbow function at their last follow-up. The 11 living patients were evaluated using the Musculoskeletal Tumour Society and Toronto Extremity Salvage scoring systems. The mean scores achieved were 76% (67% to 87%) and 73% (59% to 79%), respectively. Overall, 17 of 18 patients had significant improvement in the degree of their pain following operation.

Custom-made endoprosthetic reconstruction of the elbow for bone tumours is a viable treatment in carefully selected patients. It maintains satisfactory function and provides good pain relief.




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