Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study
Abstract Objective The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the re...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-09-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-04150-4 |
| _version_ | 1797452047284436992 |
|---|---|
| author | Lenian Zhou Juan Tang Longxiang Shen Zhichang Zhang Ting Yuan |
| author_facet | Lenian Zhou Juan Tang Longxiang Shen Zhichang Zhang Ting Yuan |
| author_sort | Lenian Zhou |
| collection | DOAJ |
| description | Abstract Objective The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the recurrence rate of distal ulna GCTB and the long-term functional outcomes of different surgery options. Methods All 28 patients received surgical treatment for distal ulna GCTB in one of three tertiary bone tumor centers between May 2007 and January 2021 with a minimum two-year follow-up. Surgical options included intralesional curettage or en bloc resection (one of 3 types). Functional outcomes were assessed by the MSTS score, the QuickDASH instrument, MWS, and MHQ according to the latest treatment. Results Overall recurrence rate was 14.2%. The curettage group (N = 7) had a significantly higher recurrence rate compared to en bloc resection (N = 21) (42.9% vs 4.8%) (mean follow-up: 88.8 mo). Seven patients received the Darrach procedure, 5 received the original Sauvé–Kapandji procedure, and 9 received the modified Sauvé–Kapandji procedure with extensor carpi ulnaris (ECU) tenodesis. Of the 4 patients having a recurrence, 1 received the Darrach EBR, 2 received the modified Sauvé–Kapandji procedure, and 1 received resection for soft tissue recurrence. Only MWS and esthetics in the MHQ scores were different (curettage, Darrach, Sauvé–Kapandji, and Sauvé–Kapandji with ECU tenodesis [MWS: 96.5 ± 1.3 vs 91.5 ± 4.7 vs 90.8 ± 2.8 vs 91.5 ± 3.6; esthetics in MHQ: 98.5 ± 3.1 vs 89.9 ± 4.7 vs 93.8 ± 4.4 vs 92.6 ± 3.8], respectively). Conclusions En bloc resection for distal ulna GCTB had a significantly lower recurrence rate compared with curettage and achieved favorable functional outcome scores. Given the higher recurrence rate after curettage, patients should be well informed of the potential benefits and risks of selecting the distal radioulnar joint-preserving procedure. Moreover, reconstructions after tumor resection of the ulna head do not appear to be necessary. |
| first_indexed | 2024-03-09T15:03:06Z |
| format | Article |
| id | doaj.art-8cea6a09976b4922b0d0652cd446949a |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-09T15:03:06Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-8cea6a09976b4922b0d0652cd446949a2023-11-26T13:49:26ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-09-011811910.1186/s13018-023-04150-4Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter studyLenian Zhou0Juan Tang1Longxiang Shen2Zhichang Zhang3Ting Yuan4Department of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Orthopaedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineAbstract Objective The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the recurrence rate of distal ulna GCTB and the long-term functional outcomes of different surgery options. Methods All 28 patients received surgical treatment for distal ulna GCTB in one of three tertiary bone tumor centers between May 2007 and January 2021 with a minimum two-year follow-up. Surgical options included intralesional curettage or en bloc resection (one of 3 types). Functional outcomes were assessed by the MSTS score, the QuickDASH instrument, MWS, and MHQ according to the latest treatment. Results Overall recurrence rate was 14.2%. The curettage group (N = 7) had a significantly higher recurrence rate compared to en bloc resection (N = 21) (42.9% vs 4.8%) (mean follow-up: 88.8 mo). Seven patients received the Darrach procedure, 5 received the original Sauvé–Kapandji procedure, and 9 received the modified Sauvé–Kapandji procedure with extensor carpi ulnaris (ECU) tenodesis. Of the 4 patients having a recurrence, 1 received the Darrach EBR, 2 received the modified Sauvé–Kapandji procedure, and 1 received resection for soft tissue recurrence. Only MWS and esthetics in the MHQ scores were different (curettage, Darrach, Sauvé–Kapandji, and Sauvé–Kapandji with ECU tenodesis [MWS: 96.5 ± 1.3 vs 91.5 ± 4.7 vs 90.8 ± 2.8 vs 91.5 ± 3.6; esthetics in MHQ: 98.5 ± 3.1 vs 89.9 ± 4.7 vs 93.8 ± 4.4 vs 92.6 ± 3.8], respectively). Conclusions En bloc resection for distal ulna GCTB had a significantly lower recurrence rate compared with curettage and achieved favorable functional outcome scores. Given the higher recurrence rate after curettage, patients should be well informed of the potential benefits and risks of selecting the distal radioulnar joint-preserving procedure. Moreover, reconstructions after tumor resection of the ulna head do not appear to be necessary.https://doi.org/10.1186/s13018-023-04150-4Giant cell tumor of boneDistal ulna tumorsWristDarrach procedureSauvé–Kapandji procedureExtensor carpi ulnaris tenodesis |
| spellingShingle | Lenian Zhou Juan Tang Longxiang Shen Zhichang Zhang Ting Yuan Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study Journal of Orthopaedic Surgery and Research Giant cell tumor of bone Distal ulna tumors Wrist Darrach procedure Sauvé–Kapandji procedure Extensor carpi ulnaris tenodesis |
| title | Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| title_full | Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| title_fullStr | Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| title_full_unstemmed | Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| title_short | Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| title_sort | giant cell tumors of the distal ulna long term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study |
| topic | Giant cell tumor of bone Distal ulna tumors Wrist Darrach procedure Sauvé–Kapandji procedure Extensor carpi ulnaris tenodesis |
| url | https://doi.org/10.1186/s13018-023-04150-4 |
| work_keys_str_mv | AT lenianzhou giantcelltumorsofthedistalulnalongtermrecurrencerateandfunctionaloutcomesofenblocresectionversuscurettageinamulticenterstudy AT juantang giantcelltumorsofthedistalulnalongtermrecurrencerateandfunctionaloutcomesofenblocresectionversuscurettageinamulticenterstudy AT longxiangshen giantcelltumorsofthedistalulnalongtermrecurrencerateandfunctionaloutcomesofenblocresectionversuscurettageinamulticenterstudy AT zhichangzhang giantcelltumorsofthedistalulnalongtermrecurrencerateandfunctionaloutcomesofenblocresectionversuscurettageinamulticenterstudy AT tingyuan giantcelltumorsofthedistalulnalongtermrecurrencerateandfunctionaloutcomesofenblocresectionversuscurettageinamulticenterstudy |