Osteoarticular allograft reconstruction of the distal radius after giant cell tumor resection

Background: Resection of the distal end of the radius is indicated in the treatment of locally aggressive primary benign and malignant bone tumors. The aim of this study was to evaluate the technique of osteoarticular allograft reconstruction of the distal radius after wide excision of a giant-cell tumor. Methods: We analyzed 15 patients retrospectively who had reconstruction of the distal aspect of the radius with use of an osteoarticular allograft, between 1981 and 2005 after excision of a giant-cell tumor with a minimum follow-up of 2 years (range: 26–125 months, median: 45 months). Results: 15 consecutive patients with a Campanacci grade 3 giant-cell tumor of the distal radius formed the study population. Three patients had a local recurrence at 8, 14 and 18 months. Non-:::union::: of the osteotomy line was diagnosed 6 months after surgery in one case and needed bone grafting. Distal radio–ulnar joint instability was observed in nine cases. Subchondral bone alterations and joint narrowing were present in all cases but were painful in only one patient. Five patients needed a revision of the osteoarticular allograft, at an average of 5.4 years (range: 0.8 to 12 years) after the initial reconstruction. The reason for the revision was a fracture of the allograft in four patients and recurrence of the tumor in one. Of the fifteen patients in whom the osteoarticular allograft survived, five patients reported no functional limitation, eight had limitation in the ability to perform strenuous activities, and two had limitation in the ability to perform moderate activities. The average range of motion of the wrist was 35 degrees of dorsiflexion, 30 degrees of volar flexion, 10 degrees of radial deviation, 14 degrees of ulnar deviation, 55 degrees of supination, and 70 degrees of pronation. Conclusion: Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft was associated with a low rate of recurrence of the tumor, a moderately high rate of revision, and little pain in association with common activities, good function, and a moderate range of motion.