The purpose of this case report is to identify the steps needed for pre-operative planning of revision intercalary prosthetic replacement for bone sarcoma, and to discuss some difficulties encountered intra-operatively in such a case. Case Report J.Q is a 55-year-old gentleman who initially underwent left mid-shaft humerus intercalary replacement for a pathological humeral fracture through a high-grade leiomyosarcoma. The surgery was performed through an antero-lateral approach in November 2006. A customised, cemented, bi-stemmed coupled device with side-to-side mating junction and 2 set screws was used following templating of the lesion.Adjuvant radiotherapy was given to the left humerus, however no chemotherapy was used. Post-operative recovery was complicated by pain and erythema of the wound secondary to radiotherapy but was otherwise uncomplicated. J.Q had been a very active person who participated in mountaineering and other vigorous exercises. He recommenced most of these activities within 3 months of surgery and approximately 9 months post-fixation he began complaining of instability of his left elbow when his arm was flexed. Blood tests were sent including: full blood count; CRP; ESR; and bone profile, all of which were normal. Radiographs of his humerus at this stage did not reveal any abnormality and so an MRI scan was performed. This showed some oedema around the distal half of the prosthesis and little else of note. There was no convincing evidence of tumour recurrence or infection.Dynamic screening radiographs were then undertaken in April 2008. These showed that the distal half of the prosthesis was loose and therefore required revision, but that the proximal half of the prosthesis was apparently well fixed. Subsequent plain radiographs have demonstrated radio-lucency at the cement-bone interface with osteolysis distally (fig 1) in keeping with the dynamic screening findings.
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