The Functional Outcomes and Complications of Different Reconstruction Methods for Giant Cell Tumor of the Distal Radius: Comparison of Osteoarticular Allograft and Three-Dimensional-Printed Prosthesis

Abstract

Background: En 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. Methods: We 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. Results: Both 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. Conclusions: Our 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.

Distal Tibial Reconstruction in the Management of Primary Bone Tumors in Children and Adolescents

“…According to some authors, osteoarticular allograft reconstruction is a long-lasting but still temporary solution before performing megaprosthesis. 3,19 Although distal tibial reconstruction using osteoarticular allografts can offer acceptable functional results, reconstruction using a custom-made titanium bone replacement system (MUTARS) gives early function recovery, allows to preserve ankle motion, and provides proper oncologic treatment. 1,2,12,17,21 Additionally, in young patients, the expandable system allows to expand the length of the limb.…”

En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

“…Despite its benign label, the distal radius is the most common primary site responsible for metastases and a high focus on ruling out pulmonary metastasis is mandatory in the pre-operative assessment [9,10,12,19] . In well-marginated cortical borders, curettage with bone grafting/cement packing is acceptable despite the recurrence rates up to 50% [4,5,7,17,19] . Campanacci grade, pathological fractures, tumor site, and adjuvant therapy are recognized predictors of local recurrence [1,19] .…”

“…Giant cell tumor of bone (GCTB) is a benign but locally aggressive intramedullary bone tumor that was first described in 1818 by Cooper and Travers [1][2][3] . The distal radius is the third most common site of GCTB after distal femur and proximal tibia [1,[4][5][6][7] . Local recurrences occur in 70% of the cases within 24 months after excision and lung metastasis in 2% of the patients [7][8][9][10] .…”

Intercalary reconstruction with successful joint preservation by uncemented 3D‑printed endoprosthesis following tumor resection in distal radius: A case report

“…The present study reported a case of wrist preservation surgery using a 3D-printed custom-made porous endoprosthesis after en bloc resection of the EHE in the distal radius. 3D-printed custom-made porous endoprosthesis is a novel uncemented implant that has demonstrated great clinical success in the reconstruction of extensive bone defects (9)(10)(11). Due to its optimized-fit shape and porous surface, it was considered a feasible alternative for the massive defect of the distal radius to preserve the intact wrist.…”