Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
JBJS Rev. 2024 May 20;12(5). doi: e24.00008. eCollection 2024 May 1.
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.
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.
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).
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 III. See Instructions for Authors for a complete description of levels of evidence.
全肱骨置换术（THR）是在切除大量肱骨肿瘤后进行的重建手术。然而，关于该植入物的失败率和功能结果的文献有限。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结果。
对 PubMed 和 Embase 数据库进行全面检索。我们在 PROSPERO（448684）上注册了我们的研究，并使用观察性研究流行病学强化报告清单（Strengthening the Reporting of Observational Studies in Epidemiology checklist）进行质量评估。使用 Henderson 分类法评估假体失败，使用肌肉骨骼肿瘤学会（Musculoskeletal Tumor Society，MSTS）评分评估功能结果。计算加权平均值和标准差。
最终纳入了 10 项研究，共 171 例接受 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%）。整个队列的 2 年、5 年和 10 年植入物存活率分别为 86%、81%和 69.3%。原发性 THR 的 10 年植入物存活率为 78.3%，而翻修 THR 为 38.6%（p = 0.049）。末次随访时的平均 MSTS 评分为 77%。未发生假体失败的患者 MSTS 评分（79.3%）高于假体失败的患者（71.4%）（p = 0.02）。
三分之一的 THR 会失败，主要原因是肿瘤进展和假体感染。整体功能评分可接受，MSTS 评分显示手和肘部功能良好，但肩部功能有限。
III 级。请参阅作者指南以获取完整的证据水平描述。
