Functional outcomes and complications of elbow endoprosthesis reconstruction after tumor resection: insights from a national study at two sarcoma centers.

Abstract

Elbow tumors, though rare, pose significant reconstructive challenges due to the joint's complex anatomy and limited soft tissue coverage. This study evaluates the functional outcomes, complications, and implant survival rates of modern-design elbow tumor endoprostheses following resection of distal humerus or proximal ulna tumors. Conducted across 2 tertiary sarcoma centers, the retrospective study analyzed 18 patients treated from 2014 to 2023. Patients underwent primary surgery with consistent surgical and postoperative protocols. The study evaluated implant survival, complications, and functional outcomes following elbow tumor resection and endoprosthetic reconstruction, using Musculoskeletal Tumor Society score, the Toronto Extremity Salvage Score, and the Modified Elbow Performance Score, and range of motion measurements. Factors influencing implant failure, including resection location, bone length, prosthesis type, allograft use, and fixation method, were also analyzed. Implant survival rates were 94%, 86%, and 65% at 1, 3, and 5 years, respectively, with cemented fixation showing lower survival at 5 years compared to uncemented fixation. Intraoperative complications included 3 transient nerve injuries and one humeral fracture, while postoperative complications, classified by the Henderson system, led to 9 revisions in 7 patients. The mean Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, and Modified Elbow Performance Score scores were 78.7% (23.6 ± 2.9), 75.4% (±8.9), and 82.2% (±9.4), respectively, with no significant differences between humeral and ulnar resections. Patients achieved a mean maximum elbow flexion of 115.26 ± 16.8° and an overall mean range of motion exceeding 100°. In this national study, elbow endoprosthetic reconstruction after tumor resection was associated with acceptable functional outcomes and a 65% 5-year implant survival rate, though revision surgery was required in nearly 40% of patients. While permanent neurological deficits were rare, the complication burden underscores the need for cautious patient selection and long-term follow-up.