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Gong T, Luo Y, Lu M, Wang J, Zhang Y, Wang Y, Tang F, Li Z, Zhou Y, Min L, Tu C. 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. J Surg Oncol 2023; 127:1043-1053. [PMID: 36825890 DOI: 10.1002/jso.27215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
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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Affiliation(s)
- Taojun Gong
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Zhuangzhuang Li
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
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Hess MC, Kafchinski L, Ransom E. Giant Cell Tumor of the Distal Radius: A Review. Orthop Clin North Am 2023; 54:75-88. [PMID: 36402513 DOI: 10.1016/j.ocl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant cell tumor of the distal radius presents a significant challenge in management due to high risk of recurrence and potential loss of function. Shared decision-making guides management, particularly for more advanced lesions. Intralesional curettage can optimize wrist function but at the cost of a higher recurrence risk. Wide resection decreases local recurrence but has higher complication rates regardless of reconstruction method. No functional difference exists between motion-preserving procedures and arthrodesis; therefore, patients should be clearly informed of the risks and benefits of each treatment option.
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Affiliation(s)
- Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Lisa Kafchinski
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA
| | - Erin Ransom
- Department of Orthopaedic Surgery, University of Alabama-Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA
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3
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Lunn K, Hoftiezer Y, Lans J, van der Heijden B, Chen N, Lozano-Calderón SA. Joint-sparing versus nonjoint-sparing reconstruction of the radius following oncologic resection: A systematic review. J Surg Oncol 2021; 124:1523-1535. [PMID: 34432294 DOI: 10.1002/jso.26660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjoint-sparing (NJS) reconstructions following oncologic resection of the distal radius. METHODS A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates. RESULTS A total of 52 nonrandomized cohort studies (n = 715) were included. PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1° vs. 25.6°) and the range of pronation-supination was greater in NJS reconstructions (133.6° vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct. CONCLUSIONS This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects. However, about 6% of JS reconstructions are eventually revised to a NJS construct. Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.
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Affiliation(s)
- Kiera Lunn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yannick Hoftiezer
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands.,Department of Plastic Surgery, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lans J, Ballatori SE, Castelein RM, Chen NC, Lozano Calderon SA. Osteoarticular allograft reconstruction after distal radius tumor resection: Reoperation and patient reported outcomes. J Surg Oncol 2021; 123:1304-1315. [PMID: 33559165 DOI: 10.1002/jso.26405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Jonathan Lans
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E Ballatori
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Neal C Chen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano Calderon
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Liu W, Wang B, Zhang S, Li Y, Hu B, Shao Z. Wrist Reconstruction after En bloc Resection of Bone Tumors of the Distal Radius. Orthop Surg 2021; 13:376-383. [PMID: 33480185 PMCID: PMC7957383 DOI: 10.1111/os.12737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Wrist reconstruction after en bloc resection of bone tumors of the distal radius has been a great challenge. Although many techniques have been used for the reconstruction of long bone defects following en bloc resection of the distal radius, the optimal reconstruction method remains controversial. This is the first review to systematically describe various reconstruction techniques. We not only discuss the indications, functional outcomes, and complications of these reconstruction techniques but also review the technical refinement strategies for improving the stability of the wrist joint. En bloc resection should be performed for Campanacci grade III giant cell tumors (GCT) as well as malignant tumors of the distal radius. However, wrist reconstruction after en bloc resection of the distal radius represents a great challenge. Although several surgical techniques, either achieving a stable wrist by arthrodesis or reconstructing a flexible wrist by arthroplasty, have been reported, the optimal reconstruction procedure remains controversial. The purpose of this review was to investigate which reconstruction methods might be the best option by analyzing the indications, techniques, limitations, and problems of different reconstruction methods. With the advancement of imaging, surgical techniques and materials, some reconstruction techniques have been further refined. Each of the techniques discussed in this review has its advantages and disadvantages. Wrist arthrodesis seems to be preferred over wrist arthroplasty in terms of grip strength and long‐term complications, while wrist arthroplasty seems to be superior to wrist arthrodesis in terms of wrist motion. All things considered, wrist arthroplasty with a vascularized fibular head autograft might be a good option because of better wrist function, acceptable grip strength, and a relatively lower complication rate. Moreover, wrist arthrodesis is still an option if the fibular head autograft reconstruction fails. Orthopaedic oncologists should familiarize themselves with the characteristics of each technique to select the most appropriate reconstruction method depending on each patient's situation.
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Affiliation(s)
- Weijian Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baichuan Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yubin Li
- Department of Orthopaedics, Linqing City People's Hospital, Linqing, China
| | - Binwu Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang Y, Min L, Lu M, Zhou Y, Wang J, Zhang Y, Yu X, Tang F, Luo Y, Duan H, Tu C. 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. BMC Musculoskelet Disord 2020; 21:69. [PMID: 32013950 PMCID: PMC6998256 DOI: 10.1186/s12891-020-3084-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
Background En bloc excision has been increasingly used for the management of giant cell tumors (GCTs) in the distal radius. An osteoarticular allograft has been used extensively for decades, and custom-made prosthesis reconstruction has been more recently applied. We aimed to compare the clinical outcomes of the two procedures. Methods We retrospectively analyzed 30 patients with Campanacci III or recurrent GCTs of the distal radius for follow-up at a mean of 33.2 months. In total, 15 underwent osteoarticular allograft reconstruction (allograft group) and 15 received cementless three-dimensional (3D)-printed prosthesis reconstruction (prosthesis group) between March 18, 2013, and May 20, 2018. All patients underwent 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 using the Henderson classification. Results Both groups showed significantly increased ROM, grip strength, Mayo score and MSTS score postoperatively. Furthermore, the extension, flexion, MSTS, and Mayo score were significantly higher in the prosthesis group. There was no significant difference in grip strength and VAS between the groups. In allograft group, one patient had a late infection one had resorption of allograft without allograft bone fracture. and four had wrist subluxation. All patients had degenerative changes (mean 9 months). In the prosthesis group, three patients developed wrist subluxation, three had separation of the distal radioulnar joint, and none of the patients developed wrist degeneration. Conclusions Our study compared the objective functional outcomes and complications of two reconstructive methods for Campanacci III or recurrent GCT in the distal radius. 3D-printed prosthesis replacement can partially preserve wrist function better than allograft reconstruction in the short-term. During the design of 3D-printed prosthesis, preoperative morphological assessment of the affected proximal row carpal is helpful to control postoperative dislocation. After allograft reconstruction, wrist degeneration, which has been demonstrated in all patients, severely influence their wrist function. Therefore, compared to allograft reconstruction, 3D-printed prosthesis reconstruction has irreplaceable advantages at early-stage application, especially in wrist function, however, further studied with a larger number of cases and longer follow-up.
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Affiliation(s)
- Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinzhu Yu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Ruatti S, Boudissa M, Grobost P, Kerschbaumer G, Tonetti J. Radius' Giant Cell Tumor: Allograft with Conservation of Distal Radioulnar Joint. J Wrist Surg 2019; 8:215-220. [PMID: 31192043 PMCID: PMC6546493 DOI: 10.1055/s-0039-1683364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/28/2019] [Indexed: 01/03/2023]
Abstract
Purpose Giant cell tumor of the distal radius are frequent lesions, and different types of surgeries have been described. Functional results, after conservative treatment or arthrodesis, often find a decreased strength and range of motion. The sacrifice of the distal radioulnar joint could be one of the causes. We report the case of a 26-year-old patient who presented with a Campanacci Grade III giant cell tumor of the distal radius. We managed his case by the association of en bloc resection and allograft reconstruction with the preservation of distal radioulnar joint. Hypothesis This procedure could improve functional results, without increasing the risk of recurrence at 2 years follow-up. Case Report The originality of our technique was the possibility of distal radioulnar joint conservation. We preserved a long portion of cortex bone all through the ulnar side of the distal radius. We then used an allograft of distal radius, fixed by a reconstruction anatomical plate. Results At 2 years follow-up, the range of motion was 100° with 60° of palmar flexion, 40° of extension, 75° of pronation, and 70° of supination. Radial and ulnar inclination were 10 and 15°, respectively. MTS (Musculoskeletal Tumor Society Score) 1993 was 88% and DASH score was 6. Concerning grip strength, it was measured at 85% in comparison with the other side. Pronation and supination strengths were 80 and 73%, respectively, in comparison with the other side. At follow-up, standard X-rays showed no recurrence. The allograft was well integrated. Conclusion Conservative treatment of the distal radioulnar joint allowed an almost ad integrum recovery, concerning strengths and range of motion. It allows a better functional recovery, without increasing the risk of recurrence.
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Affiliation(s)
- S. Ruatti
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - M. Boudissa
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - P. Grobost
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - G. Kerschbaumer
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - J. Tonetti
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
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8
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Qu H, Guo W, Li D, Yang Y, Wei R, Xu J. Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius. J Hand Surg Eur Vol 2019; 44:394-401. [PMID: 30557081 DOI: 10.1177/1753193418809785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twenty-one patients underwent excision of a Campanacci grade III giant cell tumour of the distal radius and had reconstruction using a proximal fibula autograft. We compared the functional results of wrist arthrodesis versus arthroplasty. All 21 patients healed in an average of 8 months, and all have remained disease free. The Musculoskeletal Tumor Society 93, the Disabilities of the Arm, Shoulder, and Hand scores and the grip strength of the operated wrist compared with the contralateral wrist were 93%, 7, and 71% for the arthrodesis group and 83%, 17, and 40% for the arthroplasty group. Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty. Level of evidence: III.
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Affiliation(s)
- Huayi Qu
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
| | - Wei Guo
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
| | - Dasen Li
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
| | - Yi Yang
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
| | - Ran Wei
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
| | - Jie Xu
- Bone and Soft Tissue Tumour Centre, People's Hospital of Beijing University, Beijing, China
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Viñuela-Prieto JM, Soria-García AM, González-Romero M, Candel FJ. Bacterial contamination rate and associated factors during bone and tendon allograft procurement from Spanish donors: exploring the contamination patterns. J Hosp Infect 2019; 102:287-294. [PMID: 30772451 DOI: 10.1016/j.jhin.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Allograft contamination during extraction represents a major limiting factor for tissue bank availability. Contamination rates remain persistently high independent of the hospital, country or year considered. AIM To analyse the factors associated with contamination of bone and tendon samples extracted from Spanish donors. METHODS Data for 1162 bone and tendon samples extracted from 102 donors between 2014 and 2017 were collected retrospectively from the hospital database. Descriptive statistics, potentially associated factors and correlation of contamination between samples extracted from different anatomical locations of the same donor were analysed. FINDINGS In total, 227 (19.54%) of the extracted samples [131 (18.49%) bone samples and 96 (20.92%) tendon samples] rendered positive cultures and were discarded. Male sex [odds ratio (OR) 2.023; P=0.019], extraction of >10 samples per donor (OR 1.997; P<0.001) and extraction time >240 min (OR 1.755; P=0.001) were factors independently associated with a higher contamination rate. Meanwhile, the tissue sample type 'bone-patellar tendon-bone' was associated with a significantly lower contamination rate (OR 0.446; P=0.001). Significant correlation between certain localization of contaminated samples and the concordance of bacterial species was also observed. CONCLUSION Factors related to the extraction procedure, such as total extraction time, extraction sequence, number of samples extracted and anatomical location of extracted samples, play a major role in allograft contamination. Further optimization of procedures, guided by the contamination patterns analysed in this study, should help to increase tissue bank availability.
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Affiliation(s)
- J M Viñuela-Prieto
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
| | - A M Soria-García
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - M González-Romero
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - F J Candel
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
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10
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Li J, Wang Z. [Progress of reconstruction in bone tumor surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:838-842. [PMID: 30129305 DOI: 10.7507/1002-1892.201806030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Bone tumor surgery involves tumor resection and subsequent reconstruction. With the development of surgical technique and new material, there is a great step toward bone and joint reconstruction in bone tumor surgery. Generally speaking, there are two major reconstructive methods including bio-reconstruction and mechanical reconstruction. In addition, three-dimensional printed prosthesis has been widely applied in the field of bone tumor surgery. The short-term result is encouraged; however, long-term results and related complications are seldom reported.
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Affiliation(s)
- Jing Li
- Department of Orthopaedics, Xijing Hospital Affiliated to the Air Force Medical University, Xi'an Shaanxi, 710032,
| | - Zhen Wang
- Department of Orthopaedics, Xijing Hospital Affiliated to the Air Force Medical University, Xi'an Shaanxi, 710032, P.R.China
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11
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Liu S, Sun L, Chai Y, Fan C, Xu Y. [Clinical application progress of the Sauvé-Kapandji procedure]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1131-1134. [PMID: 29798574 DOI: 10.7507/1002-1892.201702087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the clinical application progress of the Sauvé-Kapandji procedure. Methods The indications, techniques, effectiveness, and modifications of the Sauvé-Kapandji procedure were analyzed and evaluated by an extensive review of the relevant literature. Results The Sauvé-Kapandji procedure can be applied for various disorders of the distal radioulnar joint. Risk of series of complications exist, which might be reduced by modification of the procedure. Conclusion The Sauvé-Kapandji procedure, as a salvage operation, can be a good alternative by meticulous manipulation for appropriate cases with distal radioulnar joint disorders.
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Affiliation(s)
- Shenghe Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Luyuan Sun
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yimin Chai
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yaozeng Xu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006,
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Bus MPA, van de Sande MAJ, Taminiau AHM, Dijkstra PDS. Is there still a role for osteoarticular allograft reconstruction in musculoskeletal tumour surgery? a long-term follow-up study of 38 patients and systematic review of the literature. Bone Joint J 2017; 99-B:522-530. [PMID: 28385943 DOI: 10.1302/0301-620x.99b4.bjj-2016-0443.r2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/11/2016] [Indexed: 11/05/2022]
Abstract
AIMS To assess complications and failure mechanisms of osteoarticular allograft reconstructions for primary bone tumours. PATIENTS AND METHODS We retrospectively evaluated 38 patients (28 men, 74%) who were treated at our institution with osteoarticular allograft reconstruction between 1989 and 2010. Median age was 19 years (interquartile range 14 to 32). Median follow-up was 19.5 years (95% confidence interval (CI) 13.0 to 26.1) when 26 patients (68%) were alive. In addition, we systematically searched the literature for clinical studies on osteoarticular allografts, finding 31 studies suitable for analysis. Results of papers that reported on one site exclusively were pooled for comparison. RESULTS A total of 20 patients (53%) experienced graft failure, including 15 due to mechanical complications (39%) and three (9%) due to infection. In the systematic review, 514 reconstructions were analysed (distal femur, n = 184, 36%; proximal tibia, n = 136, 26%; distal radius, n = 99, 19%; proximal humerus, n = 95, 18%). Overall rates of failure, fracture and infection were 27%, 20%, and 10% respectively. With the distal femur as the reference, fractures were more common in the humerus (odds ratio (OR) 4.1, 95% CI 2.2 to 7.7) and tibia (OR 2.2, 95% CI 1.3 to 4.4); infections occurred more often in the tibia (OR 2.2, 95% CI 1.3 to 4.4) and less often in the radius (OR 0.1, 95% CI 0.0 to 0.8). CONCLUSION Osteoarticular allograft reconstructions are associated with high rates of mechanical complications. Although comparative studies with alternative techniques are scarce, the risk of mechanical failure in our opinion does not justify routine employment of osteoarticular allografts for reconstruction of large joints after tumour resection. Cite this article: Bone Joint J 2017;99-B:522-30.
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Affiliation(s)
- M P A Bus
- Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - M A J van de Sande
- Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A H M Taminiau
- Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - P D S Dijkstra
- Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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13
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Wang T, Chan CM, Yu F, Li Y, Niu X. 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? Clin Orthop Relat Res 2017; 475:767-775. [PMID: 26728519 PMCID: PMC5289151 DOI: 10.1007/s11999-015-4678-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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 better function). The mean grip strength was 51% (± 23%) of the uninvolved side, whereas the mean arc of forearm rotation was 113° (± 49°). CONCLUSIONS Reconstruction of defects after resection of giant cell tumor of the distal radius with autogenous structural iliac crest bone graft is a facile technique that can be used to achieve favorable functional results with complications and recurrences comparable to those of other reported techniques. We cannot show that this technique is superior to other options, but it seems to be a reasonable option to consider when other reconstruction options such as allografts are not available. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Tao Wang
- 0000 0001 2256 9319grid.11135.37Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035 P. R. China
| | - Chung Ming Chan
- 0000 0004 1936 8091grid.15276.37Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL USA
| | - Feng Yu
- 0000 0001 2256 9319grid.11135.37Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035 P. R. China
| | - Yuan Li
- 0000 0001 2256 9319grid.11135.37Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035 P. R. China
| | - Xiaohui Niu
- 0000 0001 2256 9319grid.11135.37Department of Orthopaedic Oncology, Beijing Ji Shui Tan Hospital, Peking University, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, 100035 P. R. China
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14
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Surgery for bone sarcoma of the upper extremity. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Horta R, Nascimento R, Silva A, Pinto R, Negrão P, São-Simão R, Carvalho J, Santos Silva M, Amarante J. Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report. Microsurgery 2016; 36:593-597. [PMID: 27467682 DOI: 10.1002/micr.30087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 11/08/2022]
Abstract
Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion-pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé-Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation-supination was 58-0-48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score-Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593-597, 2016.
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Affiliation(s)
- Ricardo Horta
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal. .,Alameda Professor Hernâni Monteiro, Porto, Portugal.
| | - Ricardo Nascimento
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Alvaro Silva
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Rui Pinto
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Negrão
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo São-Simão
- Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Carvalho
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Marta Santos Silva
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Jose Amarante
- Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, 4202-451, Porto, Portugal.,Alameda Professor Hernâni Monteiro, Porto, Portugal
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