English

Abstract

The elbow and distal humerus are unusual sites for primary bone tumours or metastatic disease.1 Before the advent of limb-salvage surgery around 1980s, amputation or arthrodesis was the primary treatment for tumours of the upper limb and the ultimate result was not usually satisfactory. The outcome after reconstructive surgery improved with advances in imaging, staging of the bone tumours, chemotherapy and advancements in the prosthesis designs for arthroplasty. Now preservation of the upper limb with functional reconstruction with arthroplasty has become the standard treatment for patients with bone tumours. 2, 3 Total elbow arthroplasty has been used extensively for malignancy, rheumatoid arthritis, osteoarthritis and trauma.4–6 Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications.7–9 We present our experience of reconstruction with a custom-made elbow endoprosthesis (Bakshi's floppy Hinge Semi-constrained linked Prosthesis) after resection of giant cell tumour of the distal humerus with follow up of 6 and half years. CASE HISTORY: 40 year old female patient, farmer by occupation presented to us with gross swelling and pain over Left elbow and gradually aggravating since last 6 months. There was no history of trauma, high grade fever and weight loss. Radiograph was suggestive of Companacci Grade III GCT and diagnosis was conformed on histopathologically. Patient was posted for total elbow arthroplasty. Bakshi’s floppy Hinge prosthesis with bone cement used which was cost effective and readily available. OPERATIVE TECHNIQUE: General anaesthesia administered. Postero-lateral approach and excision of tumor and radial head was done. Sub-articular ‘L’ shaped cut at proximal ulna taken. Reaming of ulna and humerus was done. Component fixation at desired length with bone cement was done. Reconstruction of distal end humerus with cement was done. Components were assembled with hinged screw and locked. Post-operatively limb was immobilised in plaster of paris slab for 3 weeks and gradually elbow mobilization started over 6 weeks. Range of movement 10° to 130° with terminal mild discomfort achieved after 8 weeks. Patient could do routine activity of daily living and light wok with comfort. Patient was happy and satisfied with final outcome. Patient was followed for 6 and half years with no recurrence of bone tumour. IMPLANTS DESIGN: Linked constrained and unlinked unconstrained implants are available. The difference is the physical linking of the hinge between humeral and ulnar components in order to