Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Abstract

Background Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported. Questions/purposes (1) What is the success of union of these grafts and how long does it take? (2) How effective is the technique in achieving tumor control? (3) What complications occur with this type of arthrodesis? (4) What are the functional results of wrist arthrodesis by this technique for treating giant cell tumor of the distal radius? Methods Between 2005 and 2013, 48 patients were treated for biopsy-confirmed Campanacci Grade III giant cell tumor of the distal radius. Of those, 39 (81% [39 of 48]) were treated with wrist arthrodesis using autogenous nonvascularized iliac crest bone graft. Of those, 27 (69% [27 of 39]) were available for followup at a minimum of 24 months (mean, 45 months; range, 24-103 months). During that period, the general indications for this approach were Campanacci Grade III and estimated resection length of 8 cm or less. Followup included clinical and radiographic assessment and functional assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Musculoskeletal Tumor Society (MSTS) score, grip strength, and range of motion at every followup by the treating surgeon and his team. All functional results were from the latest followup of each patient. Results Union of the distal junction occurred at a mean of 4 months (± 2 months) and union of the proximal junction occurred at a mean of 9 months (± 5 months). Accounting for competing events, at 12 months, the rate of proximal junction union was 56% (95% confidence interval [CI], 35%-72%), whereas it was 67% (95% CI, 45%-82%) at 18 months. In total, 11 of the 27 patients (41%) underwent repeat surgery on the distal radius, including eight patients (30%) who had complications and three (11%) who had local recurrence. The mean DASH score was 9 (± 7) (value range, 0-100, with lower scores representing better function), and the mean MSTS 1987 score was 29 (± 1) (value range, 0-30, with higher scores representing better function) as well as 96% (± 4%) of mean MSTS 1993 score (value range, 0%-100%, with higher scores representing

What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius?

“…Although our results were encouraging, reconstruction with the custom unipolar prosthesis did not produce functional outcomes similar to those reported for fibular autograft or osteoarticular allograft [3,9,16,19,29]. Numerous reconstructive methods for large bone defects after en bloc resection of the distal radius have been described, including arthrodesis of the wrist; osteoarticular allograft; nonarthrodesed, nonvascularized or vascularized fibula graft; and prosthetic arthroplasty [6,8,9,11,14,19,25,29,32]. Although radiocarpal arthrodesis using various bone grafts can produce good stability, movement of the wrist is sacrificed [6,20].…”

“…However, there is a high risk of local recurrence after this treatment method for patients with moreaggressive (Grade III) GCTs [1,33]. En bloc resection of Campanacci Grade III tumors with reconstruction is associated with a lower risk of local recurrence than curettage for these aggressive lesions [6,9,32,34].…”

“…In the past, numerous procedures including arthrodesis, osteoarticular allografts, fibular autograft, and prosthetic replacement have been used for reconstructing these bone defects [6,9,15,19,29,32]. Although there are a few reports of prosthetic arthroplasty after resection of the distal radius, most have been case reports [8,11,14,15,25].…”

Radius' Giant Cell Tumor: Allograft with Conservation of Distal Radioulnar Joint

“…[1][2][3] Arthrodesis seems to be the most practiced procedure, especially because strength is often maintained. 9,[13][14][15][16] Autograft remains the gold standard to reconstruct small loss of bone. For loss of bone greater than 10 cm, vascularized fibular graft is indicated, especially combined with a soft tissue graft if needed.…”

“…For loss of bone greater than 10 cm, vascularized fibular graft is indicated, especially combined with a soft tissue graft if needed. 9,10,[13][14][15][16] In this case, we decided to keep the mobility of the radiocarpal joint, to preserve patient's range of motion. We chose allograft because we needed to keep an articular surface opposite to the patient's carpus.…”