After working for four months to get the FDA go-ahead, Richard Buch, M.D. was able to save a man’s arm. Dr. Buch, an orthopedic surgeon at The Dallas Limb Restoration Center, performed the first total humerus replacement in the U.S. using Implantcast GmbH’s MUTARS (Modular Universal Tumour and Revision System). Dr. Buch replaced the patient’s entire arm from the elbow to shoulder.
Implantcast’s First Total Humerus Replacement in U.S.

According to the September 10, 2014 news release, Implantcast is utilized in Europe, but has yet to be cleared in the U.S. Dr. Buch is the sole surgeon who has been approved to use MUTARS in this country.
The news release stated that this patient “had a severe infection in his right arm and completely lost mobility, due to damage from infection. This patient had seven prior surgeries before being referred to our center and an amputation was recommended.”
Asked what made this case so unusual, Dr. Buch told OTW, “This is the first time a silver coated prosthesis has been used in the United States. We had to seek special approval from the FDA to use the implants for this patient’s specific case. Before coming to our center this patient was told he needed to have his arm amputated but we were able to save his arm with this technology.”
As for what Dr. Buch said he’d like his orthopedic colleagues to know, he noted, “There are alternative treatments available that most do not know about. This technology allows patients with severe infections to be reconstructed better then in anything in the past, we can now save limbs that were that were previously unsalvageable.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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