Modular Endoprosthesis vs. Cement Spacer After Proximal Humerus Tumor Resection — Do We Really Gain Functional Advantage?
Reconstruction following wide resection of proximal humeral tumors remains controversial. While modular endoprostheses are often considered the more “advanced” option, their cost and potential complications raise an important question:
Do they truly provide superior functional outcomes compared to cement spacers?
In our retrospective comparative study published in BMC Musculoskeletal Disorders, we evaluated outcomes in 58 patients who underwent limb-salvage surgery for proximal humerus tumors:
-
19 patients reconstructed with modular endoprosthesis (humeral hemiarthroplasty)
-
39 patients reconstructed with nail cement spacer
🔎 Key Findings
1. Mean MSTS score:
– Endoprosthesis: 24.8 ± 1.1
– Cement spacer: 23.9 ± 1.4
→ Statistically significant difference (P = 0.018), but clinically modest
2. Complication rates were comparable:
– Endoprosthesis: 26.3%
– Cement spacer: 28.2%
3. No significant functional differences were observed in patients with or without axillary nerve or deltoid resection.
💡 Clinical Takeaway
Both modular endoprostheses and cement spacers provided durable limb-salvage reconstruction with nearly equivalent functional outcomes.
Importantly, our findings suggest no substantial added functional advantage of the more expensive modular endoprosthesis, particularly in settings where cost considerations are relevant.
This study supports thoughtful, individualized reconstructive decision-making based on:
-
Soft tissue status
-
Patient age and prognosis
-
Resource availability
-
Surgeon experience
📄 Outcomes of modular endoprosthesis reconstruction versus cement spacer reconstruction following resection of proximal humeral tumors
BMC Musculoskeletal Disorders (2022)
DOI: 10.1186/s12891-022-05432-4
Walid Atef Ebeid MD, Sherif Eldaw MD, Ismail Tawfeek Badr MD, Mohamed Kamal Mesregah MD, Bahaa Zakarya Hasan MD
Article links:
https://pubmed.ncbi.nlm.nih.gov/35597987/
https://link.springer.com/article/10.1186/s12891-022-05432-4
I would be interested to hear how others approach reconstruction after proximal humeral tumor resection:
-
Do you routinely favor endoprosthesis?
-
In which scenarios do you prefer cement spacers?
-
How heavily does cost influence your decision-making?
Follow the Topic
-
BMC Musculoskeletal Disorders
BMC Musculoskeletal Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of musculoskeletal disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
Related Collections
With Collections, you can get published faster and increase your visibility.
Micro-mechanical signaling in tendon and ligament healing
Tendon and ligament tissues are highly responsive to mechanical stimuli, and their healing is strongly influenced by cellular and molecular signaling triggered by physical loading. Advances in biomechanics, regenerative medicine, and molecular biology have improved understanding of how mechanosensors and intracellular pathways regulate tissue remodeling, repair, and functional recovery. This Collection seeks contributions that investigate the biological, biomechanical, and therapeutic aspects of micro-mechanical signaling in tendon and ligament healing, from fundamental mechanisms to translational applications.
Topics of interest include, but are not limited to:
- Mechanotransduction pathways in tendon and ligament tissues
- Mechanosensors involved in cellular adaptation to mechanical stress
- Intracellular signaling mechanisms regulating repair and regeneration
- Mechanical loading and its influence on tissue remodeling
- Mechanotherapy and rehabilitation strategies for musculoskeletal healing
- Extracellular matrix dynamics during tendon and ligament repair
- Stem cells, biomaterials, and tissue engineering approaches
- Biomechanical and computational models of tendon and ligament healing
- Neural, inflammatory, and regenerative responses to mechanical stimulation
- Translational, preclinical, and clinical studies related to tendon and ligament recovery
All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer-review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.
Publishing Model: Open Access
Deadline: Jun 11, 2027
Alignment strategies in total knee arthroplasty
As the field of total knee arthroplasty moves beyond a one-size-fits-all mechanical alignment paradigm, increasing attention is being paid to personalized alignment strategies that aim to restore native knee anatomy, joint kinematics, and functional biomechanics. This collection will explore the theoretical foundations, technical execution, and clinical implications of kinematic, functional, restricted, and mechanical alignment approaches, as well as their role within modern, patient-centered total knee arthroplasty (TKA) practice to highlight how different alignment strategies affect postoperative function, implant survivorship, complication rates, and patient-reported outcomes.
Topics of interest include, but are not limited to:
- Comparative outcomes of mechanical, kinematic, functional, and restricted alignment in total knee arthroplasty
- Development and clinical application of personalized alignment strategies
- Biomechanical and kinematic implications of different alignment philosophies
- Impact of alignment strategy on patient-reported outcomes, function, and satisfaction
- Alignment considerations in complex or atypical knee anatomy
- Integration of alignment strategies with modern surgical techniques and technologies
All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer-review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.
Publishing Model: Open Access
Deadline: May 12, 2027
