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Current Reviews in Musculoskeletal Medicine

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01-12-2015 | Orthopedic Oncology: New Concepts and Techniques (JH Schwab, Section Editor)

Proximal humeral osteoarticular allografts: technique, pearls and pitfalls, outcomes

Authors: German L. Farfalli, Miguel A. Ayerza, D. Luis Muscolo, Luis A. Aponte-Tinao

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2015

Abstract

Allograft transplantation is a biologic reconstruction option for massive bone defects after resection of bone sarcomas. This type of reconstruction not only restores bone stock but it also allows us to reconstruct the joint anatomically. These factors are a major concern, especially in a young and active population.

We are describing indications, surgical techniques, pearls and pitfalls, and outcomes of proximal humeral osteoarticular allografts, done at present time in our institution.

We found that allograft fractures and articular complications, as epiphyseal resorption and subchondral fracture, are the main complications observed in proximal humerus osteoarticular allograft reconstructions. Nevertheless, only fractures need a reconstruction revision. Joint complications may adversely affect the limb function, but for this reason, an allograft revision is rarely performed.

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Teunis T, Nota SP, Hornicek FJ, Schwab JH, Lozano-Calderón SA. Outcome after reconstruction of the proximal humerus for tumor resection: a systematic review. Clin Orthop Relat Res. 2014;472:2245–53. This study is a systematic review that compers the results of proximal humerus osteoarticular allograft, endoprosthesis and allograft-prosthesis composite. They conclude that allograft-prosthesis composites and prostheses seem to have similar functional outcome and survival rates, and both seem to avoid fractures that are observed with osteoarticular allografts.PubMedCentralCrossRefPubMed

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Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL. Allograft reconstruction for the treatment of musculoskeletal tumors of the upper extremity. Sarcoma. 2013;2013:925413. This study evaluate outcomes of massive allograft reconstruction in the upper extremity. They conclude that articular deterioration and fracture were the most frequent mode of failure in proximal humeral osteoarticular reconstructions and allograft resorption in elbow reconstructions. The best functional score was observed in the intercalary humeral allograft.

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van de Sande MA, Dijkstra PD, Taminiau AH. Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction. Int Orthop. 2011;35:1375–80. This study compares biological versus prosthetic reconstructions of the proximal humerus. They conclude that an endoprosthetic reconstruction resulted in the lowest complication rate, highest implant survival and comparable functional results when compared to allograft-prosthesis composite and osteoarticular allograft use. They believe that the surgical approach that best preserves the abductor mechanism and provides sufficient surgical exposure for tumor resection contributed to better functional results and glenohumeral stability in the endoprosthetic group.PubMedCentralCrossRefPubMed

Title: Proximal humeral osteoarticular allografts: technique, pearls and pitfalls, outcomes
Authors: German L. Farfalli
Miguel A. Ayerza
D. Luis Muscolo
Luis A. Aponte-Tinao
Publication date: 01-12-2015
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 4/2015
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-015-9308-5

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Proximal humeral osteoarticular allografts: technique, pearls and pitfalls, outcomes

Abstract

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