Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint

Injury. 2016 Oct:47 Suppl 4:S78-S83. doi: 10.1016/j.injury.2016.07.041. Epub 2016 Aug 18.


Background: Reconstruction of large bone defects around the elbow joint is surgically demanding due to sparse soft tissue coverage, complex biomechanics and the close proximity to neurovascular structures. Modular megaprostheses are established reconstruction tools for the elbow, but only small case series have been reported in the literature.

Methods: Thirty-six patients who underwent reconstruction of the elbow joint with a modular megaprosthesis were reviewed retrospectively. In 31 patients (86.1%), elbow replacement was performed after resection of a bone tumour, whereas five non-oncological patients (13.9%) underwent surgery because of a previous failed elbow reconstruction. Functional outcome, rate of complications and oncological results were considered as primary endpoints.

Results: The mean follow-up was 25 months. The average achieved Mayo Elbow Performance Score (MEPS) was 77.08 (range 40-95) and the average Musculoskeletal Tumor Society (MSTS) score was 22.9 (range 8-30). Six complications (16.7%) were observed: two radial palsies, one temporary radial nerve dysfunction, one ulnar palsy, one disassembling of the articular prosthesis component and one deep infection necessitating the only implant removal. The overall 5-year survival rate of the patients was poor (25.1%) because of rapid systemic progression of the oncological disease in patients with metastatic lesion. However, the 5-year survival rate of the implant was very satisfactory (93%).

Conclusions: Modular megaprosthesis is a reliable and effective reconstruction tool in large bone defects around the elbow joint. The complication rates are lower than seen in osteoarticular allografts and allograft-prosthesis composites while the functional outcome is equal. In palliative situations with metastatic disease involving the elbow, modular megaprosthesis enables rapid recovery and pain relief and preserves elbow function.

Keywords: Bone tumour; Complex fracture; Distal humerus; Elbow; Modular megaprosthesis; Reconstruction.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / physiopathology
  • Bone Neoplasms / surgery*
  • Child
  • Elbow Joint / diagnostic imaging
  • Elbow Joint / pathology*
  • Elbow Joint / surgery
  • Female
  • Humans
  • Intra-Articular Fractures / diagnostic imaging
  • Intra-Articular Fractures / physiopathology
  • Intra-Articular Fractures / surgery*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Plastic Surgery Procedures* / methods
  • Prosthesis Design
  • Prosthesis Failure
  • Prosthesis Implantation / adverse effects*
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult