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Limb-Sparing Resection for Tumors Involving the Distal Humerus and Reconstruction with a Modular Endoprosthesis
ORTHOPAEDIC SURGERY
an effective alternative. In this article we present a series of patients treated with a hinged semi-constrained modular distal humeral replacement. The goal of this study is to describe our surgical technique, functional outcomes, and complication rates.
Lightfix: A Prospective, Multi-Center Study of the Photodynamic Bone Stabilization System for the Treatment of Impending and Actual Pathological Fractures from Metastatic Bone Disease in the Humerus Ivan Golub, Alexander P Decilveo, Jacob Topfer, Ian T O’Connor, Joel R Peterson, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ
METHODS: We retrospectively reviewed the charts of 9 patients treated for tumors of the distal humerus between 2002 and 2013. Patients were followed for a minimum of 2 years or until death (average: 34 months, range: 3-68 months). The functional status was rated using the Musculoskeletal Tumor Society scoring system.
INTRODUCTION: IlluminOss is a new technology enabling percutaneous, customized, intramedullary stabilization via an implant that consists of a Dacron balloon and a light curable monomer. The implant is used to treat actual and impending pathological fractures of the humerus due to metastatic cancer. Its potential clinical benefits include less blood loss, faster procedure time, shorter length of hospitalization, less pain, and more functional improvement in comparison to existing treatments.
RESULTS: The average postoperative Musculoskeletal Tumor Society score for the 9 patients was 81% (range: 63% to 97%). Seven patients were pain-free and 2 patients had persistent mild pain at followup. All patients had normal shoulder function and the ability to use their hand and elbow for daily activities. Complications included one superficial wound infection, 3 bushing failures, and 1 median nerve entrapment that were all successfully treated. There were no instances of deep infections or loosening requiring revisions.
METHODS: From July 2012 to May 2015, over 100 actual/ impending pathological humeral fractures have been treated using IlluminOss internationally. We report on the first use of the product at our institution on 6 patients. For each procedure the tumor was removed, the fracture was reduced, a Dacron balloon was inserted into the medullary canal across the fracture site, the balloon was infused and expanded with a biocompatible liquid monomer, and visible light curing system was used to quickly polymerize the monomer causing it to harden and form a customized bone stabilization nail. Patients undergo 1 year of follow up.
CONCLUSIONS: Tumors involving the distal humerus can be safely resected and reliably reconstructed with a modular semi-constrained prosthesis. Emphasis should be placed on gentle and meticulous neurovascular dissection and appropriate soft tissue reconstruction to optimize functional results and minimize complications.
RESULTS: There were no device related complications from the over 100 patients treated with the device internationally. The procedures performed at our institution experienced no intraoperative complications and have shown excellent results in terms of recovery rate, pain, and function.
Long-Term Update on Constrained “Rotator Cuff Substituting” Total Scapula Prosthesis for Shoulder Girdle Tumors Drew E Murray, Brett Hayden, MD, Alexander P Decilveo, Ivan Golub, Jacob Topfer, Ian T O’Connor, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Tufts Medical Center, Medford, MA
CONCLUSIONS: The IlluminOss implant and procedure provide patients with a minimally invasive bone stabilization system that allows for less soft tissue damage and faster recovery in comparison to existing treatments for actual and impending pathological fractures of the proximal humerus.
INTRODUCTION: The traditional resection technique for malignant tumors of the scapula is the Tikhoff-Linberg procedure but more recently total scapula prostheses have been used that substitute for the resected rotator cuff by preventing upward migration of the humeral head with deltoid contraction. The goal of this study is to evaluate the functional outcomes, range of motion, and complications associated with reconstruction using a constrained total scapular endoprosthesis after scapulectomy.
Limb-Sparing Resection for Tumors Involving the Distal Humerus and Reconstruction with a Modular Endoprosthesis Joel R Peterson, Alexander P Decilveo, Ivan Golub, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
METHODS: We retrospectively analyzed charts of 6 patients with neoplasms arising in the scapula from 2003-2009. In all patients, the deltoid, trapezius, latissimus dorsi, rhomboids, serratus anterior, and axillary nerve were capable of being preserved which permitted implantation of the total scapula prosthesis. At final follow-up, all patients were assessed for outcome according to the Musculoskeletal Tumor Society (MSTS) score. Pain, range of motion of the shoulder and elbow, local tumor control, implant survival, and complications were also assessed.
INTRODUCTION: Prior to 1970, the preferred treatment for tumors of the distal humerus was amputation. Early attempts at limb salvage (resection arthroplasty, allograft arthrodesis, and allograft replacement) have been associated with multiple complications and poor functional results. Recently, endoprosthetic reconstruction of the distal humerus and elbow joint has become
e27
http://dx.doi.org/10.1016/j.jamcollsurg.2016.08.073 ISSN 1072-7515/16
an effective alternative. In this article we present a series of patients treated with a hinged semi-constrained modular distal humeral replacement. The goal of this study is to describe our surgical technique, functional outcomes, and complication rates.
Lightfix: A Prospective, Multi-Center Study of the Photodynamic Bone Stabilization System for the Treatment of Impending and Actual Pathological Fractures from Metastatic Bone Disease in the Humerus Ivan Golub, Alexander P Decilveo, Jacob Topfer, Ian T O’Connor, Joel R Peterson, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ
METHODS: We retrospectively reviewed the charts of 9 patients treated for tumors of the distal humerus between 2002 and 2013. Patients were followed for a minimum of 2 years or until death (average: 34 months, range: 3-68 months). The functional status was rated using the Musculoskeletal Tumor Society scoring system.
INTRODUCTION: IlluminOss is a new technology enabling percutaneous, customized, intramedullary stabilization via an implant that consists of a Dacron balloon and a light curable monomer. The implant is used to treat actual and impending pathological fractures of the humerus due to metastatic cancer. Its potential clinical benefits include less blood loss, faster procedure time, shorter length of hospitalization, less pain, and more functional improvement in comparison to existing treatments.
RESULTS: The average postoperative Musculoskeletal Tumor Society score for the 9 patients was 81% (range: 63% to 97%). Seven patients were pain-free and 2 patients had persistent mild pain at followup. All patients had normal shoulder function and the ability to use their hand and elbow for daily activities. Complications included one superficial wound infection, 3 bushing failures, and 1 median nerve entrapment that were all successfully treated. There were no instances of deep infections or loosening requiring revisions.
METHODS: From July 2012 to May 2015, over 100 actual/ impending pathological humeral fractures have been treated using IlluminOss internationally. We report on the first use of the product at our institution on 6 patients. For each procedure the tumor was removed, the fracture was reduced, a Dacron balloon was inserted into the medullary canal across the fracture site, the balloon was infused and expanded with a biocompatible liquid monomer, and visible light curing system was used to quickly polymerize the monomer causing it to harden and form a customized bone stabilization nail. Patients undergo 1 year of follow up.
CONCLUSIONS: Tumors involving the distal humerus can be safely resected and reliably reconstructed with a modular semi-constrained prosthesis. Emphasis should be placed on gentle and meticulous neurovascular dissection and appropriate soft tissue reconstruction to optimize functional results and minimize complications.
RESULTS: There were no device related complications from the over 100 patients treated with the device internationally. The procedures performed at our institution experienced no intraoperative complications and have shown excellent results in terms of recovery rate, pain, and function.
Long-Term Update on Constrained “Rotator Cuff Substituting” Total Scapula Prosthesis for Shoulder Girdle Tumors Drew E Murray, Brett Hayden, MD, Alexander P Decilveo, Ivan Golub, Jacob Topfer, Ian T O’Connor, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Tufts Medical Center, Medford, MA
CONCLUSIONS: The IlluminOss implant and procedure provide patients with a minimally invasive bone stabilization system that allows for less soft tissue damage and faster recovery in comparison to existing treatments for actual and impending pathological fractures of the proximal humerus.
INTRODUCTION: The traditional resection technique for malignant tumors of the scapula is the Tikhoff-Linberg procedure but more recently total scapula prostheses have been used that substitute for the resected rotator cuff by preventing upward migration of the humeral head with deltoid contraction. The goal of this study is to evaluate the functional outcomes, range of motion, and complications associated with reconstruction using a constrained total scapular endoprosthesis after scapulectomy.
Limb-Sparing Resection for Tumors Involving the Distal Humerus and Reconstruction with a Modular Endoprosthesis Joel R Peterson, Alexander P Decilveo, Ivan Golub, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
METHODS: We retrospectively analyzed charts of 6 patients with neoplasms arising in the scapula from 2003-2009. In all patients, the deltoid, trapezius, latissimus dorsi, rhomboids, serratus anterior, and axillary nerve were capable of being preserved which permitted implantation of the total scapula prosthesis. At final follow-up, all patients were assessed for outcome according to the Musculoskeletal Tumor Society (MSTS) score. Pain, range of motion of the shoulder and elbow, local tumor control, implant survival, and complications were also assessed.
INTRODUCTION: Prior to 1970, the preferred treatment for tumors of the distal humerus was amputation. Early attempts at limb salvage (resection arthroplasty, allograft arthrodesis, and allograft replacement) have been associated with multiple complications and poor functional results. Recently, endoprosthetic reconstruction of the distal humerus and elbow joint has become
e27
http://dx.doi.org/10.1016/j.jamcollsurg.2016.08.073 ISSN 1072-7515/16