Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb: A Systematic Review of the Literature.

IF 1.7 Q2 SURGERY

JBJS Reviews Pub Date : 2024-05-20 eCollection Date: 2024-05-01 DOI:10.2106/JBJS.RVW.24.00008

Marcos R Gonzalez, Joseph O Werenski, Santiago A Lozano-Calderon

{"title":"Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb: A Systematic Review of the Literature.","authors":"Marcos R Gonzalez, Joseph O Werenski, Santiago A Lozano-Calderon","doi":"10.2106/JBJS.RVW.24.00008","DOIUrl":null,"url":null,"abstract":"Background: Total humerus replacement (THR) is a reconstruction procedure performed after resection of massive humeral tumors. However, there is limited literature on the rates of failure and functional outcomes of this implant. Our study aimed to determine the main failure modes, implant survival, and postoperative functional outcomes of THR.Methods: A comprehensive search of the PubMed and Embase databases was conducted. We registered our study on PROSPERO (448684) and used the Strengthening the Reporting of Observational Studies in Epidemiology checklist for quality assessment. The Henderson classification was used to assess endoprosthesis failure and the Musculoskeletal Tumor Society (MSTS) score for functional outcomes. Weighted means and standard deviations were calculated.Results: Ten studies comprising 171 patients undergoing THR were finally included. The overall failure rate was 32.2%. Tumor progression (12.6%) and prosthetic infections (9.4%) were the most common failure modes, followed by soft-tissue failures (5.9%), aseptic loosening (3.5%), and structural failure (1.8%). Two-year, 5-year, and 10-year implant survival rates for the entire cohort were 86%, 81%, and 69.3%. Ten-year implant survival for primary THRs was 78.3%, compared with 38.6% for revision THRs (p = 0.049). The mean MSTS score at the last follow-up was 77%. Patients whose implants did not fail had a higher MSTS score (79.3%) than those with failed implants (71.4%) (p = 0.02).Conclusion: One-third of THR will fail, mostly due to tumor progression and prosthetic infection. Overall functional scores were acceptable, with MSTS scores displaying great hand and elbow function but limited shoulder function.Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 5","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.RVW.24.00008","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Total humerus replacement (THR) is a reconstruction procedure performed after resection of massive humeral tumors. However, there is limited literature on the rates of failure and functional outcomes of this implant. Our study aimed to determine the main failure modes, implant survival, and postoperative functional outcomes of THR.

Methods: A comprehensive search of the PubMed and Embase databases was conducted. We registered our study on PROSPERO (448684) and used the Strengthening the Reporting of Observational Studies in Epidemiology checklist for quality assessment. The Henderson classification was used to assess endoprosthesis failure and the Musculoskeletal Tumor Society (MSTS) score for functional outcomes. Weighted means and standard deviations were calculated.

Results: Ten studies comprising 171 patients undergoing THR were finally included. The overall failure rate was 32.2%. Tumor progression (12.6%) and prosthetic infections (9.4%) were the most common failure modes, followed by soft-tissue failures (5.9%), aseptic loosening (3.5%), and structural failure (1.8%). Two-year, 5-year, and 10-year implant survival rates for the entire cohort were 86%, 81%, and 69.3%. Ten-year implant survival for primary THRs was 78.3%, compared with 38.6% for revision THRs (p = 0.049). The mean MSTS score at the last follow-up was 77%. Patients whose implants did not fail had a higher MSTS score (79.3%) than those with failed implants (71.4%) (p = 0.02).

Conclusion: One-third of THR will fail, mostly due to tumor progression and prosthetic infection. Overall functional scores were acceptable, with MSTS scores displaying great hand and elbow function but limited shoulder function.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

查看原文本刊更多论文

上肢肿瘤性重建的全肱骨置换术后效果：文献的系统性回顾。

背景：全肱骨置换术（THR）是切除巨大肱骨肿瘤后进行的重建手术。然而，关于这种植入物的失败率和功能结果的文献却很有限。我们的研究旨在确定 THR 的主要失败模式、植入物存活率和术后功能效果：我们对 PubMed 和 Embase 数据库进行了全面检索。我们在PROSPERO（448684）上注册了我们的研究，并使用加强流行病学观察性研究报告清单进行质量评估。亨德森分类法用于评估假体植入失败，肌肉骨骼肿瘤协会（MSTS）评分用于评估功能结果。计算加权平均值和标准差：结果：最终纳入了 10 项研究，包括 171 名接受 THR 的患者。总体失败率为 32.2%。肿瘤进展（12.6%）和假体感染（9.4%）是最常见的失败模式，其次是软组织失败（5.9%）、无菌性松动（3.5%）和结构性失败（1.8%）。整个组群的两年、五年和十年植入物存活率分别为 86%、81% 和 69.3%。初次全脊椎置换术的十年植入存活率为 78.3%，而翻修全脊椎置换术的十年植入存活率为 38.6%（P = 0.049）。最后一次随访时的平均 MSTS 得分为 77%。植入物未失败的患者的MSTS评分（79.3%）高于植入物失败的患者（71.4%）（p = 0.02）：结论：三分之一的 THR 会失败，主要原因是肿瘤进展和假体感染。总体功能评分尚可，MSTS评分显示手部和肘部功能良好，但肩部功能有限：证据等级：三级。有关证据等级的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.