Background. Hip resurfacing arthroplasty (HRA) has seen a recent revival with third generation Metal-on-Metal prostheses and is now widely in use. However, safety and effectiveness of hip resurfacing are still questioned. We systematically reviewed peer-reviewed literature on hip resurfacing arthroplasty to address these issues. Objective. To evaluate implant survival and functional outcomes of hybrid Metal-on-Metal hip resurfacing arthroplasty (HRA). Method. Electronic databases and reference lists were searched from 1988 to May 2010. Identified abstracts were checked for inclusion or exclusion by two independent reviewers. Data were extracted and summarized by one reviewer and verified by a second reviewer. Main study endpoint was implant survival, which we compared with the National Institute of Clinical Excellence (NICE) benchmark. We also evaluated radiological and functional outcomes, failure modes and other adverse events. The quality of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). Results. We identified 539 articles, of which 29 met the inclusion criteria. The studies included one randomised clinical trial, 27 prospective case series and one retrospective case series. Data were extracted from these 29 articles, totalling 10621 resurfaced hips, providing details on five out of 11 resurfacing devices on the market. Mean follow up ranged from 0.6 to 10.5 years and implant survival ranged from 84% to 100%. Of the 10621 hips, 370 were revised (3.5%), with aseptic loosening as most frequent failure mode. None of the HRA implants used to date met the full 10 year NICE benchmark. Thirteen studies showed satisfactory implant survival percentages compared to the three year NICE entry-benchmark. These 13 studies used the BHR implant (eight studies), the Conserve plus (two studies), the Durom implant (one study), the Cormet 2000 implant (one study) or both the McMinn and the BHR implant (one study)

Introduction. The current investigation includes a retrospective review of the experience of five Institutions with distal femur megaprostheses for tumor over a twenty year period, to analyze the incidence and etiology of failure, using a new classification system based upon the failure modes. Methods. Between 1974 and 2008, 2174 patients underwent primary limb preservation for a benign or malignant extremity tumor using a metallic megaprosthesis at five Institutions, 951 (43.7%) were distal femur replacements. Retrospective analysis of complications according to the Letson and Ruggieri Classification was performed and Kaplan-Meier curves of implant survival were defined. Segmental megaprosthetic reconstruction failures were categorized as mechanical and non-mechanical failures. Results. A total of 951 skeletally mature patients received a segmental endoprosthesis for the treatment of an oncologic condition. Overall 261 (27%) of the primary procedures were considered failures. There were 137 mechanical failures (14.4%): 12 (1.3%) Type 1 (soft tissue failure), 65 (6.8%) Type 2 (aseptic loosening), and 60 (6.3%) Type 3 (structural failure). Non-mechanical causes accounted for 124 failures (13%): 45 (4.7%)Type 4 (tumor progression) and 79 (8.3%) Type 5 (infection). The overall implant survival to all modes of failure was 77% at 10 years and 73% at 20 years. The implant survival to aseptic loosening was over 90% at 10 years. Conclusion. Most frequent cause of failure was infection followed by aseptic loosening and structural failure. The implant survival at long term was quite satisfactory

United Kingdom National Institute for Health and Clinical Excellence guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractures of the femoral neck in cognitively intact patients, who were independently mobile prior to the injury. This study aimed to analyse the risk factors associated with revision of the implant and mortality following THR, and to quantify risk. National Joint Registry data recording a THR performed for acute fracture of the femoral neck between 2003 and 2010 were analysed. Cox proportional hazards models were used to investigate the extent to which risk of revision was related to specific covariates. Multivariable logistic regression was used to analyse factors affecting peri-operative mortality (< 90 days). A total of 4323 procedures were studied. There were 80 patients who had undergone revision surgery at the time of censoring (five-year revision rate 3.25%, 95% confidence interval 2.44 to 4.07) and 137 patients (3.2%) patients died within 90 days. After adjusting for patient and surgeon characteristics, an increased risk of revision was associated with the use of cementless prostheses compared with cemented (hazard ratio (HR) 1.33, p = 0.021). Revision was independent of bearing surface and head size. The risk of mortality within 90 days was significantly increased with higher American Society of Anesthesiologists (ASA) grade (grade 3: odds ratio (OR) 4.04, p < 0.001; grade 4/5: OR 20.26, p < 0.001; both compared with grades 1/2) and older age (≥ 75 years: OR 1.65, p = 0.025), but reduced over the study period (9% relative risk reduction per year).

THR is a good option in patients aged < 75 years and with ASA 1/2. Cementation of the femoral component does not adversely affect peri-operative mortality but improves survival of the implant in the mid-term when compared with cementless femoral components. There are no benefits of using head sizes > 28 mm or bearings other than metal-on-polyethylene. More research is required to determine the benefits of THR over hemiarthroplasty in older patients and those with ASA grades > 2.

Restoration of native Coronal Plane Alignment of the Knee (CPAK) phenotype is a strategy suggested to achieve better satisfaction. The aim of this study was to investigate the influence of changes in CPAK classification on patient-reported outcome measures (PROMs) and survivorship in a large cohort of manual mechanically aligned (MA) cemented TKAs. A retrospective analysis of 1062 consecutive cemented TKAs using MA philosophy at a single institution. Pre- and post-operative hip-knee-ankle radiographs were classified using the CPAK classification. Oxford Knee Score (OKS) and patient satisfaction (4-point-Likert scale) were collected prospectively. Implant survival data was obtained from our national arthroplasty database. We compared the outcomes of patients who maintained or changed their CPAK classification following TKA. Satisfaction was analysed using chi-square test, and OKS was analysed using Mann-Whitney test. Pre-operatively, most patients were CPAK type-I (38.8%). 85.5% of patients changed their CPAK type post-operatively, with CPAK type-V observed in 41.2% of these. Significantly better satisfaction (p=0.033) and OKS (p=0.021) were observed at one-year follow-up in patients who changed CPAK type, although the difference was below OKS minimally important clinical difference. There was no difference in satisfaction (p=0.73) and OKS (p=0.26) at one year between CPAK-V and non-V classifications. Post-operative CPAK type had no correlation with satisfaction and OKS. 12 TKAs (1.1%) were revised within 10 years (3 septic). In this large cohort of MA-TKA, excellent survivorship was observed at 10 years, with no demonstrable difference in outcome related to the final CPAK phenotype or change in phenotype

Total Hip Arthroplasty (THA) is one of the most successful and cost-effective treatments available for painful hip arthritis. Unfortunately, dislocation following primary THA is one of the most common complications, occurring in approximately 0.50–10percnt; cases. However, there is little literature that investigates the effects that dislocation has on the patient's overall function and satisfaction. We reviewed 229 THA patients that had sustained dislocation from a prospective database, consisting 156 single dislocations and 73 with two or more. Patient outcomes were compared with a matched control group of 196 patients without dislocation in the same follow-up period. Harris Hip Score (HHS) and patient satisfaction were recorded pre-operatively and at one, five and ten years post-operatively. Mann-Whitney test compared HHS between control and dislocation groups, Chi-Square test compared patient satisfaction and implant survival. Total HHS and functional component were significantly lower in the dislocation group at one, five and ten years (p<0.05). HHS Pain component revealed a significant difference but only at one and three years (p<0.05). Patient satisfaction only showed a significant difference at one-year review. Dislocation rates were significantly higher in females. Implant survivorship was significantly lower in the dislocation group at 15-years. Hip-function and implant survival is significantly reduced following prosthesis dislocation, however patient satisfaction and pain levels appear unaffected at long-term follow-up

Aims

Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients.

Endoprosthetic replacement of the proximal femur may be required to treat primary bone tumours or destructive metastases either with impending or established pathological fracture. Modular prostheses are available off the shelf and can be adapted to most reconstructive situations for this purpose. We have assessed the clinical and functional outcome of using the METS (Stanmore Implants Worldwide) modular tumour prosthesis to reconstruct the proximal femur in 100 consecutive patients between 2001 and 2006. We compared the results with the published series for patients managed with modular and custom-made endoprosthetic replacements for the same conditions. There were 52 males and 48 females with a mean age of 56.3 years (16 to 84) and a mean follow-up of 24.6 months (0 to 60). In 65 patients the procedure was undertaken for metastases, in 25 for a primary bone tumour, and in ten for other malignant conditions. A total of 46 patients presented with a pathological fracture, and 19 presented with failed fixation of a previous pathological fracture. The overall patient survival was 63.6% at one year and 23.1% at five years, and was significantly better for patients with a primary bone tumour than for those with metastatic tumour (82.3% vs 53.3%, respectively at one year (p = 0.003)). There were six early dislocations of which five could be treated by closed reduction. No patient needed revision surgery for dislocation. Revision surgery was required by six (6%) patients, five for pain caused by acetabular wear and one for tumour progression. Amputation was needed in four patients for local recurrence or infection. The estimated five-year implant survival with revision as the endpoint was 90.7%. The mean Toronto Extremity Salvage score was 61% (51% to 95%). The implant survival and complications resulting from the use of the modular system were comparable to the published series of both custom-made and other modular proximal femoral implants. We conclude that at intermediate follow-up the modular tumour prosthesis for proximal femur replacement provides versatility, a low incidence of implant-related complications and acceptable function for patients with metastatic tumours, pathological fractures and failed fixation of the proximal femur. It also functions as well as a custom-made endoprosthetic replacement

Paget's disease of bone (PDB) is the second most common metabolic bone disease. Osteoarthritis (OA) affects one-third of patients with PDB. The incidence of THR (total hip replacement) and TKR (total knee replacement) is 3.1- and 1.7-fold higher in PDB patients compared to non-affected age-matched controls. No large studies or joint registry reports exist describing the outcomes following THR or TKR in patients with PDB. The objectives of this study were to investigate the outcomes following THR and TKR in patients with PDB using national joint registry data. 144 THR and 43 TKR were identified using the Scottish Arthroplasty Project from 1996–2013. For THR, the most common early post-operative surgical complications were haematoma formation (1.4%), and surgical site infection (1.4%). The absolute incidence during follow-up of dislocation was 2.8%, and revision hip arthroplasty was performed in 2.8% of cases. Implant survival of the primary prosthesis was 96.3% (CI: 92.8 – 99.8) at 10-years, and patient survival was 50.0% (39.6 – 60.4) at 10-years. For TKR, the most common early post-operative surgical complication was surgical site infection (2.3%). The absolute incidence during follow-up of revision knee arthroplasty was 4.7%. On survival analysis, implant survival of the primary prosthesis was 94.5% (CI: 87.1 – 100) at 10-years, and patient survival was 38.3% (16.7 – 59.9) at 10-years. This is the largest reported series of outcomes following primary THR and TKR in patients with PDB. PDB patients are not at increased risk of surgical complications following primary THR or TKR compared to non-PDB patients

Aims

Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.

Background. Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. Design. This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset. Discussion. Evidence on the optimum choice of prosthesis for hemiarthroplasty of the hip is lacking. National guidance is currently based on expert opinion rather than empirical evidence. The incidence of hip fracture is likely to continue to increase and providing high quality evidence on the optimum treatment will improve patient outcomes and have important health economic implications. Cite this article: A. L. Sims. The World Hip Trauma Evaluation Study 3: Hemiarthroplasty Evaluation by Multicentre Investigation – WH. I. TE 3: HEMI – An Abridged Protocol. Bone Joint Res 2016;5:18–25. doi: 10.1302/2046-3758.51.2000473

INTRODUCTION. Cementless Total Hip Replacement surgery is a well established procedure for relative young patients with severe hip disease. Excellent long term clinical results have been published on the performance of the femoral component. With growing clinical experience, our concern focused on excessive wear of the Ultra High Molecular Weight Polyethylene (UHMWPE) ringloc liner of the Mallory Head cementless Total Hip Prosthesis. After its introduction in our clinic in 1997, this implant is still in use without any modification. We were concerned that due to premature liner wear, the performance of this implant would not be compliant with the international guideline on implant survival (NICE guidelines: at 10 year follow up, 90% of all implants should still be in situ). Our objective was to establish the amount of liner wear in our first 200 MH implants. METHODS. Our first 200 patients consecutively treated with Mallory Head prostheses were followed up to obtain a recent digital image. Follow up was complete for 181 (90.5%) of our 200 patients. Ten had died and nine were not able or willing to come for follow up. The mean duration of follow up was 8.3 years (range: 8–13). The 181 recent digital images were classified as either excessive wear or no excessive wear by two independent orthopedic surgeons. Next, liner wear was measured in the 2D frontal plane using PolyWare Pro/3D Digital Version Rev 5.1 software (Draftware Developers, Conway, USA). A threshold for excessive liner wear was set at 0.2mm/year, according to literature. RESULTS. Using software for measuring PE wear, 46.7% of all patients had excessive UHMWPE wear (> 0.2mm/yr). There was no relation between the amount of wear and BMI, gender, component size or the acetabular inclination angle. Thirteen patients (6.5%) were revised. Nine of these revisions were for excessive liner wear or aseptic loosening (4.5%). For now, our series of cementless Mallory Head prostheses is compliant with the NICE guideline on implant survival. However, with the measured amount of wear we expect to see a significant increase in the number of revisions for liner wear in the near future. DISCUSSION. Our clinical observation of premature UHMWPE wear proved correct. The measured amount of UHMWPE wear is consistent with the few other studies published on this subject. Although we present a retrospective study, limiting the strength of our results, we have included a large group of patients with acceptable loss to follow up. It is unclear if the observed wear will lead to a sharp increase in the number of revisions within the next few years. Possibly, future revisions will be complicated by loss of acetabular bone stock following the pathofysiological reaction to wear particles. Our results can probably be generalised for any district hospital

Aims

The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and intramedullary nails (IMNs) with regard to fracture stability.

Aims

Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited.

A multicentre retrospective study of 879 total hip replacements (THR) was undertaken to investigate any differences in outcome between trainee surgeons and consultants. The effect of trainee supervision was also assessed. The primary outcome measures were survivorship and the Harris Hip Score (HHS). Length of stay was a secondary outcome. Patients were evaluated pre-operatively and at 1, 3, 5, 7 and 10 years post-operatively. Surgical outcome was compared between junior trainees, senior trainees and consultants. The effect of supervision was determined by comparing supervised and unsupervised trainees. There was no significant difference in post-operative HHS among consultants, senior and junior trainees at 1 year (p=0.122), at 3 years (p=0.282), at 5 years (p=0.063), at 7 years (p=0.875), or at 10 years (p=0.924) follow up. Additionally there was no significant difference in HHS between supervised and unsupervised trainees at 1 year (p=0.220), 3 years (p=0.0.542), 5 years (p=0.880), 7 years (p=0.953) and 10-year (p=0.787) follow-up. Comparison of surgical outcome between the supervised and unsupervised trainees also shows no significant difference in hospital stay (p=0.989), or implant survival years (p=0.257). This study provides evidence that when trainees are appropriately supervised, they can obtain equally good results compared with consultants when performing THR

The surgical treatment of unicompartmental knee osteoarthritis remains controversial. This study aims to compare the medium-term outcomes of age and gender matched patients treated with unicompartmental knee replacement (UKR) and total knee replacement (TKR). We retrospectively reviewed pain, function and total knee society scores (KSS) for every UKR and age and gender matched TKR in NHS Tayside, with up to 10 years prospective data from Tayside Arthroplasty Audit Group. KSS was compared at 1, 3 and 5 years. Medical complications and joint revision were identified. Kaplan-Meier with revision as end-point was used for implants survival analysis. 602 UKRs were implanted between 2001 and 2013. Preoperative KSS for pain and total scores were not significantly different between UKRs and TKRs whereas preoperative function score was significantly better for UKRs. Function scores remained significantly better in UKRs from preoperative until 3 years follow up. Further analysis revealed no statistically significant difference in the change of function scores in both groups over time. There was a trend for TKRs to perform better than UKRs in pain scores. Total KSS for both groups were not significantly different at any point of the 5-year study. Fewer medical complications were reported in the UKR group. Kaplan-Meier analysis showed a survival rate of 93.7% in UKRs and of 97% in TKRs (Log rank p-value = 0.012). The revision rate for UKR was twice as much as TKR. The theoretical advantages of UKR are not borne out by the findings in this study other than immediate postoperative complications

Component malalignment has long been implicated in poor implant survival in Total Knee Arthroplasty (TKA). Malalignment can occur in orientation of bony cuts, and in component cementation/implantation. Several systems exist to aid bony cut alignment (navigation, shape matching), but final implantation technique is common to all TKA. Correction of errors in bony cut alignment at cementation/implantation by surgeons has been described. Changes in alignment at this stage are likely to result in asymmetrical cement penetration, which is implicated in early failure. This study reviewed a consecutive series of 150 primary cemented TKAs using an imageless navigation system (aiming for neutral overall limb alignment). Deviation at implantation was calculated by comparing limb alignment recorded using the trial components with limb alignment recorded with the final implanted components, prior to closure. 136 patients (91%) had a final overall limb alignment within 2° of neutral. Three patients (2%) had a final overall limb alignment greater than 3° from neutral. Deviation occurring at implantation is shown in Figure 1 with deviations distributed around zero (mode 0, median 0.3, range −2 to +4,)

We report a retrospective review of outcome after shoulder hemiarthroplasty for proximal humerus fractures. All patients managed with shoulder hemiarthroplasty for proximal humerus fractures between 1997 and 2008 were included. Clinical notes were reviewed and surviving patients completed postal Oxford Shoulder Score (OSS) questionnaires. Results were analysed to assess whether there was a difference in outcome for those above the age of 70 years. A total of 96 patients were treated during this period. Female to male ratio was 3.36:1 with mean age 72 ± 9.6 (45–93) years at time of fracture. At time of review 30.2% of patients were dead. Two patients were lost to follow-up after discharge. Complete case notes were available in 68 patients. Response rate to the OSS was 67.2%. There were 20 patients below 70 years and 48 patients above 70 years of age. The ASA grade was II in 60% of patients. Mean follow-up was 52 months. There were 2 in hospital post-operative deaths due to medical complications. Mean OSS was 27 (3–47) of a maximum of 48, with no significant difference between groups. Overall complication rate was 27.9%, with no significant difference between groups. Ten year survival was 96.9% overall with no significant difference between groups. There appears to be no significant difference in functional outcome, complication rate, or implant survival between patients below or above the age of 70 years treated with primary hemiarthroplasty for fracture of the proximal humerus. This procedure however carries a high complication rate in this group of patients

Introduction. Since the introduction of 3rd generation Metal-on-Metal-Hip-Resurfacing-Arthroplasty (MoMHRA), thousands of such prostheses have been implanted worldwide in younger patients with end-stage hip osteoarthritis. However, no independent centre has reported their medium-to-long term outcome. The aim of this study is to report the ten year survival and outcome of the Birmingham Hip Resurfacing (BHR), the most commonly used MoMHRA worldwide. Methods. Since 1999, 648 BHRs were implanted in 555 patients, the majority of which were male (326). The mean age at surgery was 52.1years (range: 17–82), with primary OA as most common indication (85%). Mean follow up was 7.1years (range: 1–11). The Oxford Hip Score (OHS) and UCLA questionnaires were sent to all patients. Implant survival was established, with revision as the end point. Sub-analysis was performed by gender, femoral component size (small: <45mm, standard: 46–52, large: >53mm) and age at surgery (young:<50yrs, old:>50yrs). Results. Preliminary results show that survival and clinical outcome were better in men than women (p=0.013) and in patients with large and standard components compared to small (p=0.005). In women the survival and clinical outcome were worse in the young than the old (p=0.049). In men there was no difference in survival or clinical outcome between the young and old (p=0.106). In young men the 10-year survival was 95%, the mean OHS was 45 and the mean UCLA score was 8.1. Conclusion. The results of resurfacing are good in men. They perform particularly well in the young and highly active men who tend to have problems with conventional hip replacements

Charlson Index has been found to predict functional outcome, implant survival, mortality, length of hospital stay and resource use after arthroplasty. Obesity can influence the outcome following lower limb arthroplasty. Our aim was to identify if there was a relationship between Charlson index, obesity and disability and whether this relationship had altered in recent years. Demographic details, Charlson index, BMI, SF-12 and oxford score were recorded prospectively for 88 consecutive patients undergoing lower limb arthroplasty between August 2011 and January 2012(Group B). The results were compared with Charlson index of 92 consecutive patients between August 2005 and March 2006(Group A). The mean age for Group A was 70 years (range 41–90). 56(61%) were female and 36(39%) male. The mean Carlson index was 3 (range 0–6) and median was 3. The mean age for Group B was 67 years (range 45–91). 53(60%) were female and 35(40%) male. The mean Charlson index was 2.2 (range 0–11) and median was 0. The difference between the groups was statistically significant with a P value of 0.001. The mean BMI for Group B was 31 (range 15–56) and median 30. Thirteen patients (15%) had BMI<25, 29 patients (33%) had BMI between 25–29. 9(Pre-Obese), 23 patients (26%) had BMI between 30–34. 9(Obese-Class 1), 10 patients (11%) had BMI between 35–39. 9(Obese-Class 2)and 13 patients (15%) had BMI>40 (Obese-Class 3). The only difference between group B1(BMI<30) and B2(BMI>30) was of age with a P value of 0.0003 (72 vs 59 years). The current group had less comorbidity but 85% of patients were overweight or obese. These patients were younger but there was no difference in their health or disability before surgery. The high prevalence of obesity may represent treatment selection of these patients away from waiting list centres. Consideration about the treatment of obesity should be given before lower limb arthroplasty

Aim. Bone metastases of the upper limb are a frequent complication of primary tumors. The aim of this study is to evaluate treatment and functional results of patients with prosthetic reconstruction of the proximal humerus. Method. Between 1975 and 2007, 67 patients were treated by resection of humeral metastasis and reconstruction with prosthesis. Cemented modular prostheses of the proximal humerus were implanted in 59 cases (all MRS Bioimpianti® prostheses), uncemented prostheses in 2 (HMRS® Stryker), 4 elbow Coonrad-Morrey prostheses (in 2 cases with bone allograft), 1 elbow custom-made cemented and 1 intercalary prosthesis (Osteobridge Merete®). Sites of primary tumors: kidney (23), lung (13), bone and unknow (7 each), liver and breast (3 each), bladder, endometrium, thyroid, soft tissues and nervous tissues (2 each), ovarium (1). Complications were evaluated and univariate analysis with actuarial Kaplan-Meier curves of implant survival was performed. Functional results were assessed with the MSTS system. Results. At mean follow-up 27 months oncologic outcome showed 7 patients NED (mean time 7 yrs.), 57 DOD, 3 lost to follow-up. Complications were deep infection (2 cases, 3%) and loosening (1 case, 1.5%) causing failure requiring revision. Functional results were good or excellent in 93% of patients, with average score of 71%. Conclusion. Resection of metastatic lesion is indicated: 1) for patients with solitary metastases and long free interval from treatment of primary cancer, 2) for patients with meta-epiphyseal metastases not amenable to durable internal fixation even in presence multiple metastases. Indications of resections are increasing, due to prolonged survival with newer medical treatments. Different reconstructive techniques are available, depending on type of resection and soft tissues removal. Cemented prostheses are mostly used, since cemented fixation is not affected by radiotherapy. Although prognosis was poor, prosthetic reconstructions of the humerus provided satisfactory results