Abstract：
BACKGROUND: Distal humerus replacement (DHR) is a modular endoprosthesis mainly used for bone reconstruction after resection of primary or metastatic bone lesions. Studies on DHR failure rates and postoperative functional outcomes are scarce. We sought to assess implant survival, modes of failure, and functional outcomes in patients undergoing DHR for oncologic indications.
METHODS: A systematic review of the PubMed and Embase databases was performed. PRISMA guidelines were followed for this manuscript. Our study was registered on PROSPERO (457,260). Quality appraisal of included studies was conducted using the STROBE checklist. Prosthetic failure was assessed using the Henderson classification for megaprosthetic failures. We additionally performed a retrospective review of patients treated with a DHR for oncologic indications at a large tertiary care academic center. Weighted means were calculated to pool data.
RESULTS: Eleven studies with a total of 162 patients met the inclusion criteria. Mean follow-up was 3.7 years (range, 1.66-8 years). Henderson type 2 failures (aseptic loosening) were the most common mode of failure, occurring in 12% of cases (range, 0%-33%). Five-year implant survival was 72% (range, 49%-93.7%). Mean postoperative Musculoskeletal Tumor Society (MSTS) score was 81.1 (range, 74-84.3). In our institutional case series, 2 out of 5 patients had DHR revision for periprosthetic fracture and aseptic loosening at 16 and 27 months after surgery, respectively.
CONCLUSIONS: Distal humerus replacement is a successful reconstruction strategy for tumors of the distal humerus, with high implant survival and good to excellent functional outcomes.
METHODS: A systematic review of the PubMed and Embase databases was performed. PRISMA guidelines were followed for this manuscript. Our study was registered on PROSPERO (457,260). Quality appraisal of included studies was conducted using the STROBE checklist. Prosthetic failure was assessed using the Henderson classification for megaprosthetic failures. We additionally performed a retrospective review of patients treated with a DHR for oncologic indications at a large tertiary care academic center. Weighted means were calculated to pool data.
RESULTS: Eleven studies with a total of 162 patients met the inclusion criteria. Mean follow-up was 3.7 years (range, 1.66-8 years). Henderson type 2 failures (aseptic loosening) were the most common mode of failure, occurring in 12% of cases (range, 0%-33%). Five-year implant survival was 72% (range, 49%-93.7%). Mean postoperative Musculoskeletal Tumor Society (MSTS) score was 81.1 (range, 74-84.3). In our institutional case series, 2 out of 5 patients had DHR revision for periprosthetic fracture and aseptic loosening at 16 and 27 months after surgery, respectively.
CONCLUSIONS: Distal humerus replacement is a successful reconstruction strategy for tumors of the distal humerus, with high implant survival and good to excellent functional outcomes.
摘要：
背景：肱骨远端置换（DHR）是一种模块化内置假体，主要用于切除原发性或转移性骨病变后的骨重建。关于DHR失败率和术后功能结局的研究很少。我们试图评估植入物的存活率，失效模式,以及接受DHR治疗的肿瘤适应症患者的功能结局。
方法：对PubMed和Embase数据库进行了系统评价。本手稿遵循PRISMA指南。我们的研究在PROSPERO（457,260）上注册。使用STROBE检查表对纳入研究进行质量评估。使用Henderson分类对大型假体失败进行评估。我们还对在大型三级护理学术中心接受DHR治疗的肿瘤适应症患者进行了回顾性审查。计算加权平均值以汇集数据。
结果：11项研究共162例患者符合纳入标准。平均随访时间为3.7年(范围，1.66-8年）。亨德森2型失效（无菌性松动）是最常见的失效模式，发生在12%的病例中(范围，0%-33%）。5年植入物生存率为72%（范围，49%-93.7%）。术后平均肌肉骨骼肿瘤协会（MSTS）评分为81.1（范围，74-84.3).在我们的机构案例系列中，5例患者中有2例在术后16和27个月因假体周围骨折和无菌性松动而进行了DHR翻修，分别。
结论：肱骨远端置换是肱骨远端肿瘤的成功重建策略，具有较高的植入物存活率和良好至优异的功能结果。
方法：对PubMed和Embase数据库进行了系统评价。本手稿遵循PRISMA指南。我们的研究在PROSPERO（457,260）上注册。使用STROBE检查表对纳入研究进行质量评估。使用Henderson分类对大型假体失败进行评估。我们还对在大型三级护理学术中心接受DHR治疗的肿瘤适应症患者进行了回顾性审查。计算加权平均值以汇集数据。
结果：11项研究共162例患者符合纳入标准。平均随访时间为3.7年(范围，1.66-8年）。亨德森2型失效（无菌性松动）是最常见的失效模式，发生在12%的病例中(范围，0%-33%）。5年植入物生存率为72%（范围，49%-93.7%）。术后平均肌肉骨骼肿瘤协会（MSTS）评分为81.1（范围，74-84.3).在我们的机构案例系列中，5例患者中有2例在术后16和27个月因假体周围骨折和无菌性松动而进行了DHR翻修，分别。
结论：肱骨远端置换是肱骨远端肿瘤的成功重建策略，具有较高的植入物存活率和良好至优异的功能结果。
