Clinical Outcomes of Different Surgical Methods for Campanacci Grade III and Recurrent Giant Cell Tumors of the Distal Radius.

Background: Campanacci grade III and recurrent giant cell tumors (GCTs) of the distal radius are aggressive, but treatments are scare, and universally accepted surgical strategy has not been established. The purpose of this study was to compare the clinical outcomes of different surgical methods for these tumors.

Methods: We retrospectively analyzed 26 patients with Campanacci grade III or recurrent GCT of the distal radius between 2017 and 2023 in this study. Patients were divided into intralesional curettage group (n = 12) and wide excision group (n = 14). According to the different reconstruction methods, the wide excision group was further divided into two subgroups, including the arthroplasty subgroup (n = 8) and the arthrodesis subgroup (n = 6). All patients underwentsurgeries, and perioperative denosumab was recommended. Pre- and postoperative active range of motion (ROM) of the wrist, grip strength, visual analog score, Mayo wrist score and Musculoskeletal Tumor Society score were assessed. Postoperative complications, denosumab application, and tumor recurrence were also evaluated.

Results: The intralesional curettage group was superior to the wide excision group in reservation of ROM of the wrist but related to higher local recurrence rate (25% vs. 7.1%). Postoperative pain relief and satisfaction of the patients were more obvious in the wide excision group compared with the intralesional curettage group. Arthroplasty and arthrodesis following wide excision provided similar improvements in grip strength, visual analog score, Mayo wrist score, and Musculoskeletal Tumor Society scores after surgery. Arthroplasty better reserved ROM of the wrist but associated with more complications especially wrist instability and revision surgery than arthrodesis. Arthrodesis restricted flexion, extension, and radial and ulnar deviations of the wrist but related to few instability complications.

Conclusion: Wide excision was the preferred choice for Campanacci grade III and recurrent GCT of the distal radius considering adequate local control, good pain relief, and satisfaction. Extended intralesional curettage with postoperative denosumab administration was also a reasonable alternative with better functional outcomes but increased risk of recurrence and possibility of wide excision revision surgery in the future. Arthroplasty following wide excision could reserve the motion of wrist but associated with frequent wrist instability and relatively high revision surgery rate. Arthrodesis could ensure a more stable wrist, and it is recommended for manual workers.

Level Of Evidence: Level III; Retrospective Cohort Comparison; Treatment Study.