Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius

Zhang, Shuai; Xu, Meitao; Wang, Xuquan; Wang, Jiajia

doi:10.1007/s00776-015-0763-z

Cited by 25 publications

(55 citation statements)

References 26 publications

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“…These results indicate that macromolecular polyethylene may be more suitable for articular surface reconstruction than ceramic material. Inconsistent with the findings of Zhang et al [35], different degrees of degenerative changes were observed in the reconstructed wrist at the medium-term followup (52 months) in our study, which might be related to progressive radius and ulnar translocation resulting from a relatively short prosthesis and reduced wrist motion. A previous study showed that wrist subluxation often occurred after prosthetic arthroplasty, which might limit wrist function [15].…”

Section: Discussionsupporting

confidence: 90%

“…Primary en bloc tumor resection, especially for Campanacci Grade III GCTs, has been advocated to minimize the risk of recurrence [1,34]. The use of prosthetic arthroplasty for reconstruction of the resulting distal radial defects has been reported with varying success [8,11,14,15,25,35]. However, the information provided by these reports is limited because of the small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…We observed that the functional results with the en bloc approach and custom unipolar prosthesis allowed patients to return to reasonable function and good pain control. The prosthesis can replace large bone defects, restore radiocarpal joint anatomy, and preserve wrist function while avoiding complications seen with bulk allografts or autografts [8,11,14,15,25,35]. Since Gold's report in 1957 [12], many types of prostheses have been used for reconstructing defects after en bloc resection of the distal radius, which obtained reasonable functional outcome (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with other hinged prostheses, the nonhinged wrist prostheses may have a lower risk of loosening because of the complex motion mode of the wrist axis [14]. Zhang et al [35] treated 11 patients with GCTs of the distal radius using custom unipolar prostheses with the articular surface of the macromolecular polyethylene liner, and obtained reasonable functional outcomes at an average followup of 55.5 months. These results indicate that macromolecular polyethylene may be more suitable for articular surface reconstruction than ceramic material.…”

Section: Discussionmentioning

confidence: 99%

“…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]. One other group [35] specifically evaluated this treatment approach. However, they looked at a mixed group of Grade II and Grade III lesions; we believe that Grade II lesions may be better treated with curettage, and that using this approach in the less-aggressive tumors may have resulted in overestimation of the treatment's efficacy.…”

Section: Introductionmentioning

confidence: 99%

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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?

Wang

Liu

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Purpose A giant cell tumor (GCT) of bone presenting in the distal radius is rare, however, when they occur, Campanacci Grade III tumors can present formidable reconstructive challenges. They are associated with a high local recurrence rate with intralesional treatment, therefore approaches to reconstruct the wrist after en bloc resection warrant study. Questions We asked: (1) What are the functional outcomes after en bloc resection and reconstruction of the wrist with a unipolar prosthesis in patients with Grade III GCT of the distal radius? (2) What complications occur with use of a unipolar prosthesis in these patients? (3) What are the oncologic outcomes with using en bloc resection and reconstruction with a custom unipolar wrist hemiarthroplasty for Grade III GCTs of the distal radius? Methods We retrospectively analyzed 10 patients with Campanacci Grade III GCTs of the distal radius treated by a unipolar prosthesis after wide resection of the tumor between January 2008 and October 2013. During that period, all patients at our medical group who presented with a Grade III GCT of the distal radius were treated with wide resection and reconstruction using a custom unipolar implant. Pre-and postoperative pain at rest were assessed according to a 10-cm VAS score. The functional outcomes of the wrist were assessed using the modified Mayo wrist score, and the degenerative changes were evaluated radiographically by a new rating system based on the Knirk and Jupiter scale. We also analyzed tumor recurrence, metastases, and complications associated with the reconstruction procedure. All patients were available for followup at a mean of 52 months (range, 24-90 months). Results Although the complication rate associated with prosthetic arthroplasty was relatively high (six of 10), none of our patients experienced severe complications. Two patients reported having occasional pain of the involved wrist at the time of final followup (VAS, preoperative versus postoperative: 0 versus 3; 5 versus 2, respectively). The mean modified Mayo wrist score was 68 (range, 45-90). Degenerative changes were found in three wrists (Grade 1, two patients; Grade 2, one patient). Aseptic loosening occurred in one patient and wrist subluxation occurred in two patients. Lung metastases or local tumor recurrence were not observed. Conclusions Because of the proportion of patients who had complications and progressive degeneration with this approach, we recommend first exploring alternatives to reconstruction with custom unipolar wrist hemiarthroplasty after resection of Grade III GCTs of the distal radius, such as fibular autografting. However, this technique provides an alternative for patients with concerns regarding possible morbidity associated with autografting, and for situations when allograft is not available.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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?

Wang

Liu

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Osteoarticular allograft reconstruction after distal radius tumor resection: Reoperation and patient reported outcomes

Lans

Ballatori

Castelein

et al. 2021

Journal of Surgical Oncology

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Background The aims of this study are to evaluate the rate of wrist joint preservation, allograft retention, factors associated with reoperation and to report the patient reported outcomes after osteoarticular allograft reconstruction of the distal radius. Methods Retrospective chart review identified 33 patients who underwent distal radius resection followed by osteoarticular allograft reconstruction, including 27 giant cell tumors and 6 primary malignancies. Ten patients with a preserved wrist joint completed the QuickDASH, PROMIS‐CA physical function, and Toronto extremity salvage score (TESS) at a median of 13 years postoperatively. Results The allograft retention rate was 89%, and an allograft fracture predisposed to conversion to wrist arthrodesis. The reoperation rate was 55% and 36% underwent wrist arthrodesis at a median of 4.2 years following index surgery. The use of locking plate fixation was associated with lower reoperation and allograft fracture rates. Patients reported a median QuickDASH of 10.2 (range: 0–52.3), a mean PROMIS physical function of 57.8 (range: 38.9–64.5) and the median TESS was 95.5 (range: 67.0–98.4). Conclusion Osteoarticular allograft reconstruction results in acceptable long‐term patient reported outcomes, despite a high revision rate. Allograft fixation with locking plates seems to reduce the number of reoperations and allograft fractures, along with reduction in wrist arthrodesis rates.

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The optimal strategy for 3D‐printed uncemented endoprosthesis for the bone defect reconstruction of the distal radius, based on biomechanical analysis and retrospective cohort study

Gong

Luo

et al. 2023

Journal of Surgical Oncology

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Introduction Prosthetic reconstruction after resecting giant cell tumor of bone (GCTB) of the distal radius has been proposed. However, this is generally associated with various complications. To improve the functional outcomes, we designed a three‐dimensional (3D)‐printed uncemented endoprosthesis. Meanwhile, using finite‐element analysis and clinical observation, an optimization strategy was explored. Materials and Methods We retrospectively analyzed patients with Campanacci III or recurrent GCTB of the distal radius who underwent 3D‐printed uncemented endoprosthesis reconstruction. Clinically, according to the different palmar tilts of the endoprosthesis, patients were divided into the biological angle (BA) group and the zero‐degree (ZD) group. We recorded and evaluated the differences in functional outcomes and complications between the two groups. Biomechanically, four 3D finite‐element models (normal and customized endoprostheses with three different implemented palmar tilts) were developed. Results We analyzed 22 patients (12 males and 10 females). The median follow‐up period was 60 (range, 19–82) months. Of the 22 patients, 11 patients were included in the BA group and the remaining 11 patients were in the ZD group. Both groups showed no significant differences in the range of motion, Mayo score, and disabilities of the arm, shoulder, and hand scores postoperatively. The subluxation rate was significantly lower in the ZD group than in the BA group. The biomechanical results showed similar stress and displacement distribution patterns in the normal and prosthetic reconstruction models. Additionally, the endoprosthesis with 0° palmar tilt showed better biomechanical performance. Conclusion 3D‐printed uncemented endoprosthesis provides acceptable midterm outcomes in patients undergoing distal radius reconstruction. Optimizing the design by decreasing the palmar tilt may be beneficial for decreasing the risk of wrist joint subluxation.

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Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius

Cited by 25 publications

References 26 publications

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?

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?

Osteoarticular allograft reconstruction after distal radius tumor resection: Reoperation and patient reported outcomes

The optimal strategy for 3D‐printed uncemented endoprosthesis for the bone defect reconstruction of the distal radius, based on biomechanical analysis and retrospective cohort study

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