What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction follo
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01779-7
What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction following primary bone sarcoma resection? Nikolaus W. Lang · Maximilian F. Kasparek · Lukas Synak · Wenzel Waldstein · Philipp T. Funovics · Reinhard Windhager · Gerhard M. Hobusch
Received: 2 May 2020 / Accepted: 16 November 2020 © The Author(s) 2020
Summary Background The aim of the study was to assess (1) sports activity, (2) sports involving the upper extremities, (3) functional outcome and (4) sports-related complications of long-term survivors of primary malignant bone tumors of the proximal humerus. Methods A total of 18 patients with an endoprosthetic reconstruction for primary malignant bone sarcoma of the proximal humerus (8 male, 10 female, mean age 19.9 ± 8.4 years, range 7.8–37.4 years) with an average follow-up of 18.1 ± 7.4 years (range 6.7–29.8 years) were included. The type of sport, frequency, duration of each sport session and the University of California, Los Angeles (UCLA) activity score were assessed before surgery, at 1 year, 3 years and at the latest followup. Functional outcome was assessed by the Toronto extremity salvage score (TESS). Results The mean UCLA activity score decreased from 8.0 (±1.3, range 5–9) preoperative to 4.2 (±1.7, range 3–8) at 1-year follow-up (p < 0.05). After 3 years it increased to 5.1 (±1.75, range 3–8) and further to 7 (±1.8, range 4–9) at the last follow-up. The mean postoperative TESS was 80.8 (±6.4, range 75.7–91.4) at the latest follow-up. Patients who were initially more active without reconstruction including a synthetic mesh were more likely to develop soft tissue complications accompanied by proximal endoprothesis migration. Conclusion Patients with a modular endoprosthetic reconstruction of the humerus following primary bone sarcoma resume participation in sports. RegardN. W. Lang, MD · M. F. Kasparek, MD · L. Synak, MD · W. Waldstein, MD · P. T. Funovics, MD · R. Windhager, MD · G. M. Hobusch, MD () Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria [email protected]
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ing the low incidence of periprosthetic infections, utilization of a synthetic mesh for reconstruction to prevent soft tissue complications in active patients should be considered. Keywords Bone sarcoma · Megaprosthesis · Synthetic mesh · Complications · Postoperative functional outcome
Introduction The proximal humerus is the third most common site of primary bone sarcomas [1]. Endoprosthetic reconstruction is a successful treatment option for limb reconstruction after bone tumor resection or metastatic disease of the humerus [2–6]. Adequate en bloc resection of the tumor is often accompanied by pronounced loss of soft and bone tissues. Therefore, these procedures result in a loss of function of the involved extremity [7]. Moreover, chemotherapy has a negative impact on metabolic function and muscle strength, resulting in prolonged rehabilitation [8,
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