Distal Humerus and Total Elbow Prosthetic 

It is a procedure that involves removing a tumor (usually malignant or benign aggressive) of the arm bone (humerus) and in most instances replacing the bone/elbow with a special customizable distal humerus tumor prosthesis.

Distal Humerus Xr

What is a limb-sparing surgery of the lower arm/elbow?

The elbow consists of your humerus, ulna, and radius bone. The distal (lower part) humerus is a relatively rare site for primary bone sarcomas and accounts for approximately 1% of all bone tumors. It is more commonly involved by neoplasm (tumor) through metastatic disease. The distal humerus or elbow joint also can be secondarily involved by soft tissue sarcomas arising from the adjacent muscles and soft tissues including undifferentiated pleomorphic sarcoma. Limb-sparing surgery can be performed for approximately 95% of tumors arising from the lower humerus. In some instances, the extremity cannot be saved and an amputation is performed.

Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, extensive disease, contamination from a poorly performed biopsy, recurrent disease.

What’s involved in the technique?

What you can expect afterwards

After your surgery you may spend a few nights in the hospital and then will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Patients are usually kept in a sling for 6 weeks to allow the muscles to heal. The elbow is not permitted to extend beyond 45 degrees of flexion for 4 to 6 weeks to allow the biceps muscle to heal, which will stabilize the prosthesis. Once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.

You will be monitored periodically with X-rays over the course of 5 years. Sometimes an MRI and/or CT may be used to additionally monitor the area to make sure the tumor has not come back. You will then have follow-up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the bone integrity has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy. 

Types Of Physical Therapy

Distal Humerus and Total Elbow Replacement Video

Dr. James Wittig narrates a video illustrating the surgical technique for resection of the distal humerus and reconstruction of the elbow joint utilizing a tumor prosthesis. | WATCH VIDEO