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 is increasingly used for the management of giant cell tumor in the distal radius. Osteoarticular allograft is extensively used for decades, also custom-made prosthesis reconstruction is recently applied widely. We aimed to firstly compare the clinical outcomes of the two procedures. Methods: We retrospectively analyzed thirty-two patients with Campanacci III or recurrent GCT of the distal radius for follow-up at a mean of 33.2 months. Sixteen underwent osteoarticular allograft reconstruction (allograft group) and sixteen received cementless three-dimensional(3D)-printed prosthesis reconstruction (prosthesis group) between March 18, 2013, and May 20, 2018. All patients were assessed 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 on the Henderson classification. Results: Both groups showed significantly increased ROM, grip strength, Mayo score and MSTS score postoperatively. MSTS and Mayo score were significantly higher in prosthesis group. There was no significant difference in grip strength and VAS between two groups. In allograft group, one had a local recurrence; one had a late infection; four had wrist subluxation. All patients had degenerative changes (mean 9 months, 95% CI: 8.03-9.97). One had resorption of allograft without allograft bone fracture. In the prosthesis group, one had a local recurrence. Three developed wrist subluxation. Three had separation of the distal radioulnar joint. None of the patients developed degeneration of wrist. Conclusions: Our study firstly compared the objective functional outcomes and complications of two reconstructive methods for the Campanacci III or recurrent GCT in the distal radius. 3D-printed prosthesis replacement can preserve better wrist function than allograft reconstruction at short-term. During 3D-printed prosthesis design, preoperative morphological assessment of affected proximal row carpal is helpful to control the postoperative dislocation. After allograft reconstruction, degeneration of wrist, which has been proved in all patients, severely influence their wrist function. Therefore, compared with allograft reconstruction, 3D-printed prosthesis reconstruction shows its irreplaceable advantages at early-stage application, especially in wrist function, but its larger cases research at longer follow-up are needed.

3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours

“…In recent years, en bloc resection followed by the use of a prosthesis for post-resection bone defect repair and reconstruction has become the preferred approach for GCT treatment among an increasing number of orthopedists. However, the poor fit of conventional prostheses leads to a high rate of complications such as implant loosening or failure, resulting in poor postoperative limb function among patients (5,6). Furthermore, the low incidence of metacarpal GCTs suggests that conventionally configured prostheses are currently unavailable for this condition.…”