Combined fixation of modular tumor proximal humeral endoprosthesis (experimental and clinical study)
Keywords:proximal humerus, stress-strain state, malignant bone tumors, modular endoprosthesis, replacement of postresection defects
Objective: to substantiate, develop and implement a more reliable combined endoprosthesis fixation system for replacement of postresectional defects of the proximal humerus, reduction in the number of complications from the endoprosthesis and improvement of the results of tumor joint replacement.
Methods: finite element models of the «endoprosthesis – humerus» system with different fixation methods (combined and intramedullary only) have been developed, investigated for tension, bending and twisting. In an experiment on 20 white rats, the situation was modeled after tumor resection of the long-bone diaphysis and replacement of the defect with a modular endoprosthesis. The animals were divided into two groups: in the experimental, an endoprosthesis was installed with a combined fixation system, in the control one — with intramedullary. Twelve patients with tumor lesion of the proximal humerus were operated: in 3 an endoprosthesis with intramedullary fixation was implanted, in 9 patients with a combined implant. The observation period is up to 7 years.
Results: on mathematical models it is determined that the use of an additional fixation system can significantly reduce the load on the «critical zone» due to its redistribution to extracortical plates. In vivo experiment, the stability of fixation and a significant reduction in the number of complications with the use of combined fixation was demonstrated. On the basis of the theoretical and experimental data obtained, the proximal humeral endoprosthesis with a combined fixation system was developed and implemented into practice. In patients operated on with the proposed fixation system, complications associated with the endoprosthesis were not revealed.
Conclusions: the use of the developed endoprosthesis with extra-cortical fixation to replace the post-exposure defects of the proximal humerus makes it possible to reduce the risk of complications associated with the implant.
Shehaden A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. ClinOrthopRelRes. 2010;468(11):S2885-95.
Eckardt JJ, Kabo M, Kelly CM,Ward WG Sr, Cannon CP.Endoprosthetic reconstructions for bone metastases. ClinOrthopRel Res. 2003;415:S254-62. doi: 10.1097/01.blo.0000093044.56370.94.
Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high grade bone sarcomas. J BoneJointSurg. Am. 1995;77:1154-65.
Sharma S., Turcotte RE, Isler MH, Wong C. Experience with cemented large segment endoprostheses for tumors. Clin. Orthop. Rel. Res. 2007;459:54-9.doi: 10.1097/BLO.0b013e3180514c8e.
Enneking W, Dunham W, Gebhardt M, Malawar M, Pritchard D. A system for the classification of skeletal resections. La Chirurgia Degli Organi Di Movimento. 1990;75(1):217-40.
Shi SF, Dong Y, Zhang CL, Bao K, Ma XJ. Prosthetic replacement of the proximal humerus after the resection of bone tumors. Chin J Cancer. 2010 Jan;29(1):121-4.
Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of amusculoskeletal tumor. J Bone Joint Surg Am. 1990;72-A:334-45.
O’Connor MI, Sim FH, Chao EY. Limb salvage for neoplasms of the shoulder girdle. J BoneJointSurgAm. 1996;78-A:1872-88.
Rödl RW, Gosheger G, Gebert C, Lindner N, Ozaki T, Winkelmann W. Reconstruction of the proximal humerus after wide resection of tumours. J Bone Joint Surg Br. 2002;84-B:1004-8.
Ad-El D, Paizer A, Pidhortz C. Bipedicled vascularized fibula flap for proximal humerus defects in a child. Plast Recons Surg. 2001;107(1):155-7.
Vyrva OЕ. Modular Custom Made Endoprosthetics in the treatment of malignant tumors of long bones: abstract dis. the M.D.; Kharkiv, 2013. 43 p.(in Ukrainian)
Vyrva OЕ, Golovina YaA, Burlaka VV, Shevchenko IV. Custom made endoprosthetics with tumors of proximal humerus. Herald of orthopedics, traumatology and prosthetics. 2005;3(46):49–53.(in Russian)
Aliev MD, Soloviev UN.Primary malignant tumors of bones. M. ROSC, 2008. 176 p.(in Russian)
Malawer MM, Sugarbaker PH. Musculoskeletal cancer surgery. Treatment of sarcomas and allied diseases. Washington: Kluwer Academic Publishers, 2001. 629 p.
Bernthal NM, Schwartz AJ, Oakes DA, Kabo JM, Eckardt JJ. How long do endoprosthetic reconstructions for proximal femoral tumors last? ClinOrthopRelRes. 2001;468(11):2867-74.doi: 10.1007/s11999-010-1369-6.
Veth R, van Hoesel R, Pruszczynski M, et al. Limb salvage in musculoskeletal oncology. TheLancetOncology. 2003;4(6):343-50.
Asavamongkolkul A, Eckardt JJ, Eilber FR, Dorey FJ, Ward WG, Kelly CM, Wirganowicz PZ, Kabo JM. Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop Rel Res. 1999;360:207-20.
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Rel Res. 2004;420:239-50.
Surin VM. Technical mechanics: Tutorial.Minsk; BSUIR, 2004. 293 p.(in Russian)
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