Modular Endoprosthesis vs. Cement Spacer After Proximal Humerus Tumor Resection — Do We Really Gain Functional Advantage?
Published in Surgery
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:
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19 patients reconstructed with modular endoprosthesis (humeral hemiarthroplasty)
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39 patients reconstructed with nail cement spacer
🔎 Key Findings
• Mean MSTS score:
– Endoprosthesis: 24.8 ± 1.1
– Cement spacer: 23.9 ± 1.4
→ Statistically significant difference (P = 0.018), but clinically modest
• Complication rates were comparable:
– Endoprosthesis: 26.3%
– Cement spacer: 28.2%
• 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:
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Soft tissue status
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Patient age and prognosis
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Resource availability
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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:
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Do you routinely favor endoprosthesis?
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In which scenarios do you prefer cement spacers?
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How heavily does cost influence your decision-making?
Dr. Mohamed Mesregah MD is an experienced orthopedic surgeon with a strong background in both clinical practice and orthopedic research. He specializes in the diagnosis and management of musculoskeletal conditions, with a commitment to delivering high-quality, patient-centered care.
With years of hands-on experience, Dr. Mesregah has developed a deep understanding of modern orthopedic techniques and evidence-based treatment approaches. His research involvement reflects his dedication to advancing medical knowledge and improving patient outcomes.
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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.
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