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. A comparative study was published in BMC Musculoskeletal Disorders.

Published in Cancer and Surgery

Modular Endoprosthesis vs. Cement Spacer After Proximal Humerus Tumor Resection — Do We Really Gain Functional Advantage?
Like

Share this post

Choose a social network to share with, or copy the URL to share elsewhere

This is a representation of how your post may appear on social media. The actual post will vary between social networks

Explore the Research

SpringerLink
SpringerLink SpringerLink

Outcomes of modular endoprosthesis reconstruction versus cement spacer reconstruction following resection of proximal humeral tumors - BMC Musculoskeletal Disorders

Background There is no agreement about the best reconstructive option following resection of proximal humerus tumors. The purpose of this study was to compare the functional outcomes of endoprosthesis reconstruction versus nail cement spacer reconstruction after wide resection of proximal humeral tumors. Methods This retrospective comparative study included 58 patients with proximal humerus tumors who had undergone tumor resection and reconstruction with modular endoprosthesis (humeral hemiarthroplasties) or cement spacer. Medical records were reviewed for the epidemiological, clinical, radiological, and operative data. Lung metastasis, local recurrence, and complication were also reviewed. The functional outcome was evaluated using the Musculoskeletal Tumor Society scoring (MSTS) system. Results Nineteen patients with a mean age of 33.4 ± 17.5 years underwent reconstruction by modular endoprosthesis, and 39 patients with a mean age of 24.6 ± 14.3 years underwent reconstruction by cement spacer. The mean MSTS score was 24.8 ± 1.1 in the endoprosthesis group and 23.9 ± 1.4 in the spacer group, P = 0.018. Complications were reported in 5 (26.3%) patients in the endoprosthesis group and 11 (28.2%) patients in the spacer group, P = 0.879. There were no statistically significant differences in the functional outcomes in both patient groups with or without axillary or deltoid resection. Conclusions Both endoprostheses and cement spacers are durable reconstructions with almost equal functional outcomes with no added advantage of the expensive endoprosthesis.

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?

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Follow the Topic

Orthopaedics
Life Sciences > Health Sciences > Clinical Medicine > Orthopaedics
Bone Cancer
Life Sciences > Biological Sciences > Cancer Biology > Cancers > Bone Cancer
Surgical Oncology
Life Sciences > Biological Sciences > Cancer Biology > Cancer Therapy > Surgical Oncology

Related Collections

With Collections, you can get published faster and increase your visibility.

Quadriceps tendon autograft anterior cruciate ligament reconstruction

BMC Musculoskeletal Disorders is calling for submissions to the Quadriceps tendon autograft anterior cruciate ligament reconstruction. The scope of this collection includes an in-depth exploration of Quadriceps Tendon Autograft (QTA) as a preferred technique in Anterior Cruciate Ligament Reconstruction (ACLR).

Topics of interest include, but are not limited to:

Technical aspects of the surgery, including graft harvesting, surgical procedure variations, and comparisons to other graft types (e.g., hamstring tendon, patellar tendon).

The implications of QTA in ACL injury repair, focusing on graft stability, functional recovery, and long-term outcomes.

Post-operative rehabilitation protocols.

Strategies for enhancing muscle strength and maintaining optimal knee function after surgery.

Common complications such as graft failure, re-injury, and the risk factors that contribute to these issues.

Researchers, clinicians, and scholars are invited to submit their work and share their findings with a global audience. By participating in this Collection, contributors will help shape the future of musculoskeletal disorder treatment and enhance the therapeutic options available to patients worldwide.

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: Oct 15, 2026

Robotic knee arthroplasty: systems, alignment strategies, and future directions

BMC Musculoskeletal Disorders is calling for submissions to our Collection entitled Robotic knee arthroplasty: systems, alignment strategies, and future directions.

Robotic-assisted knee arthroplasty has rapidly evolved into a key component of modern orthopedic surgery, offering enhanced precision, reproducibility, and the potential for personalized implant positioning. Despite its growing adoption, substantial variability exists in how robotic technologies are implemented, how alignment philosophies are selected, and how these factors influence clinical and functional outcomes. This Collection aims to bring together high-quality research focused specifically on robotic knee joint replacement surgery to advance our understanding of its capabilities, limitations, and future directions.

We particularly welcome studies that explore the different robotic systems—imageless or image-based, active, semi-active, or passive—and how their unique workflows, software planning tools, haptic control, and intraoperative decision-making affect accuracy, efficiency, learning curve, and safety. At the same time, a major focus of this Collection is the application of various alignment strategies in robotic TKA, including mechanical, kinematic, restricted kinematic, functional, or hybrid approaches. Submissions examining how these strategies define surgical boundaries, influence soft-tissue balancing, affect biomechanics, and translate into clinical outcomes, survivorship, complications, or patient satisfaction are encouraged. Research may include clinical, cadaveric, biomechanical, computational, registry-based, or review studies. By integrating evidence across technologies and philosophies, this Collection aims to guide the evolution of precision, personalization, and best practices in robotic knee arthroplasty.

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: Nov 02, 2026