Vascularized bone grafts in the treatment of juxta-articular giant-cell tumors of the bone

Abstract

The clinical results of vascularized bone grafts in 39 patients with giant-cell tumor affecting the extremity were evaluated. The sites involved were the proximal tibia (8), proximal femur (4), calcaneus (1), proximal humerus (8), and distal radius (18). Osteoarticular replacement was performed in patients with giant-cell tumor involving the radius; in 15 of these, a suitably tailored vascularized iliac crest graft was used, and in the remaining three, the fibula was used. Follow-up ranged from 2 to 7 years, with an average of 3.3 years. Clinical results were judged on the basis of functional and radiologic evaluations. Reconstructions involving the distal radius were evaluated separately from the rest of the juxta-articular grafts. Excellent results in 17 and good results in three of the juxta-articular grafts were observed. Eighteen patients with the distal radius affected were followed-up for periods ranging from 2 to 12 years. Non-union was seen in one, carpal subluxation in five, and spontaneous radiocarpal fusion in one patient. A pain-free functional wrist was retained in 17 of these 18 patients. Three local recurrences were observed (2.5 percent). The vascularized bone graft provided a good biological and mechanical support to the subchondral bone and overlying articular cartilage. Satisfactory reconstruction was thus possible following wide resection, without sacrificing joint function and with gratifying oncologic results. The use of a suitably tailored block of vascularized iliac crest is an acceptable method to preserve wrist and radio-ulnar joint motion, following excision of the distal radius affected by a giant-cell neoplasm.