Abstract
BackgroundEn bloc excision has been increasingly used for the management of giant cell tumors (GCTs) in the distal radius. An osteoarticular allograft has been used extensively for decades, and custom-made prosthesis reconstruction has been more recently applied. We aimed to compare the clinical outcomes of the two procedures.MethodsWe retrospectively analyzed 30 patients with Campanacci III or recurrent GCTs of the distal radius for follow-up at a mean of 33.2 months. In total, 15 underwent osteoarticular allograft reconstruction (allograft group) and 15 received cementless three-dimensional (3D)-printed prosthesis reconstruction (prosthesis group) between March 18, 2013, and May 20, 2018. All patients underwent by clinical and radiological examinations, including pre- and postoperative active range of motion (ROM) of the wrist, VAS score, grip strength, degenerative change of wrist, Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score. Complications were evaluated using the Henderson classification.ResultsBoth groups showed significantly increased ROM, grip strength, Mayo score and MSTS score postoperatively. Furthermore, the extension, flexion, MSTS, and Mayo score were significantly higher in the prosthesis group. There was no significant difference in grip strength and VAS between the groups. In allograft group, one patient had a late infection one had resorption of allograft without allograft bone fracture. and four had wrist subluxation. All patients had degenerative changes (mean 9 months). In the prosthesis group, three patients developed wrist subluxation, three had separation of the distal radioulnar joint, and none of the patients developed wrist degeneration.ConclusionsOur study compared the objective functional outcomes and complications of two reconstructive methods for Campanacci III or recurrent GCT in the distal radius. 3D-printed prosthesis replacement can partially preserve wrist function better than allograft reconstruction in the short-term. During the design of 3D-printed prosthesis, preoperative morphological assessment of the affected proximal row carpal is helpful to control postoperative dislocation. After allograft reconstruction, wrist degeneration, which has been demonstrated in all patients, severely influence their wrist function. Therefore, compared to allograft reconstruction, 3D-printed prosthesis reconstruction has irreplaceable advantages at early-stage application, especially in wrist function, however, further studied with a larger number of cases and longer follow-up.
Highlights
The distal radius is the third most common location for giant cell tumor (GCT) after the distal femur and proximal tibia, and approximately 10% of giant cell tumors (GCTs) involve the distal radius [1, 2]
The majority of studies do not support the theory that GCT in the distal radius are more aggressive, controversy exists on the surgical options for patients with GCT in the distal radius, as well as it’s the rate of recurrence
For Campanacci III or recurrent GCT of the distal radius, en bloc resection and reconstruction is recommended; this is associated with a lower risk of local recurrence and poorer functional outcomes than intralesional surgery [3, 5,6,7]
Summary
The distal radius is the third most common location for giant cell tumor (GCT) after the distal femur and proximal tibia, and approximately 10% of GCT involve the distal radius [1, 2]. Numerous reconstructive procedures have been described including prosthetic replacement [9,10,11], osteoarticular allograft [12, 13], allograft fusion [14], arthrodesis using bulk autograft [1, 2], ulnar translocation [15], and nonvascularized [16] or vascularized [17] fibular graft with or without arthrodesis [18]. These techniques have unique advantages and inevitable complications, a gold standard for distal wrist reconstruction has not yet been established. We aimed to compare the clinical outcomes of the two procedures
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