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

Abstract

Background: Giant cell tumors (GCT) of the distal radius at Campanacci grade II/III are particularly challenging to treat. Wide excision is the management of choice, but this creates a defect at the distal end of radius. We treated 11 cases of GCT of the distal radius by en bloc excision and custom prosthetic replacement. The purpose of this study was to present our experience and assess the functional outcomes of all patients treated with this surgery.

Materials and methods: Between 2005 and 2014, we followed up 11 patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score.

Results: Mean follow-up period was 55.5 months (24-83 months); mean resected length of the radius was 7.9 cm. One patient had tumor recurrence in the soft tissues after 15 months (recurrence rate 9.09 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.9° of dorsiflexion, 30.0° of volar flexion, 46.4° of supination, and 38.2° of pronation. Mean grip strength was 71 % (42-86 %). Overall revised MSTS score averaged 80.3 % (63.3-93.3 %) with one being excellent, five good, and five satisfactory.

Conclusion: En bloc excision and custom prosthetic replacement for a Campanacci grade II/III GCT of the distal radius results in reasonable functional outcome at intermediate follow-up evaluation. Although average ROM of the ipsilateral wrist is poorer than some studies with other techniques, this method can be considered a reasonable option.