TREATMENT OF BENIGN GIANT-CELL TUMOURS OF THE LOWER RADIUS: LONG-TERM OUTCOME IN EIGHT CASES

Abstract

Purpose: Benign giant-cell tumours of the lower radius constitute a therapeutic challenge. Curettage with bone graft is generally used, but in this localisation recurrence varies from 25% to 80% requiring repeated surgery with a high risk of losing function.

Material and methods: Eight patients (five men and three women), aged 27 to 59 years were treated by our team between 1972 and 1994. Primary care was given in our unit for six of them and two others were referred for secondary surgery after recurrence. Radiographically, five of the tumours were aggressive (two had already led to fracture) and three were progressing. Three patients were treated first by curettage and bone graft to fill the gap. For the five other patients treatment included enucleation, curretage, and cement filling followed by osteosynthesis and immediate mobilisation. All patients were followed regularly at visits every three months for two years then every six months for two more years and every year thereafter. Median follow-up was 15 years (six–25 years).

Results: There were 12 recurrences (including four in soft tissue) in five patients (three patients initially treated with bone filling and two others among the five treated with cement filling). Recurrence was noted six to 30 months after surgery. Two patients initially treated with bone filling later had an arthrodesis that was filled with cement. Patients whose gap had been filled with cement and who had recurrence were treated again with cement filling. At last follow-up, all patients were in remission but two of them had lost wrist mobility. According to the function criteria established by the European Society for Bone Tumours, the final functional result was excellent in five, good in two and fair in one. Patients treated with cement filling had wrist mobility comparable to the healthy side and did not exhibit any radiographic alteration of the joint line.

Conclusion: The risk of relapse is high after treatment of benign giant-cell tumours of the lower radius. Filling the gap with cement does not avoid the risk of relapse but can be repeated without major inconvenience as long as autologous bone does not have to be harvested and immediate mobilisation is possible. The long-term functional outcome is the best argument favouring cement filling for benign giant-cell tumours of the lower radius, even in case of voluminous, aggressive tumours leading to fracture or relapse.