Treatment of distal radius giant cell tumor with 3D-printed metal prosthesis combined with mesh patch.

Abstract

Objective: This study introduces a surgical technique involving the use of 3D-printed all-metal prostheses combined with mesh patches for the treatment of distal radial giant cell tumors, analyzing and evaluating the midterm outcomes for patients undergoing this treatment. The experience provides insights into the application of prosthesis replacement for reconstructing distal radial defects.

Methods: From January 2018 to January 2021, our center treated five cases of distal radial giant cell tumors using 3D-printed all-metal prostheses combined with mesh patches. Postoperative pain, range of motion, and grip strength were evaluated for all patients. Oncological outcomes, complications, and degenerative changes in the wrist joint were also assessed. Functional outcomes were evaluated based on the Mayo wrist score system.

Results: The average follow-up period was 40.8 months (range: 32-66months). At the last follow-up, the mean range of motion (ROM) in the affected wrists was 20° extension, 21.6° flexion, 71.2° pronation, and 50° supination. The mean grip strength on the affected side was 64.2% compared to the unaffected side, with a Mayo score of 70. There were no incidences of aseptic loosening, wrist subluxation, or infections post-prosthesis replacement, although two cases presented with distal radioulnar joint dislocation. Of these, one case demonstrated ulnar impaction syndrome with positive ulnar variance and lunate bone degenerative changes on the 12-month postoperative radiographs. No recurrences or metastases were observed.

Conclusion: Utilizing 3D-printed metal prostheses and mesh grafts for the treatment of Campanacci Grade III or recurrent giant cell tumors of the distal radius is an effective approach. This strategy provides favorable functional outcomes during the early to mid stages of treatment, while also maintaining a low risk of complications. The concurrent use of mesh grafts facilitates early postoperative exercise, thereby accelerating functional recovery. Moreover, the intraoperative protection or reconstruction of joint ligaments, along with precise matching of the prostheses, contributes to a reduction in the risk of complications.