Curettage versus wide resection followed by arthrodesis/arthroplasty for distal radius Giant cell tumours: A meta-analysis of treatment and reconstruction methods

Divesh Jalan; Akshat Gupta; Raghav Nayar; Nupur Aggarwal; Kuldeep Singh; Princi Jain

doi:10.1016/j.jor.2022.06.007

Curettage versus wide resection followed by arthrodesis/arthroplasty for distal radius Giant cell tumours: A meta-analysis of treatment and reconstruction methods

J Orthop. 2022 Jun 17:33:15-24. doi: 10.1016/j.jor.2022.06.007. eCollection 2022 Sep-Oct.

Authors

Divesh Jalan¹, Akshat Gupta², Raghav Nayar³, Nupur Aggarwal⁴, Kuldeep Singh⁵, Princi Jain⁶

Affiliations

¹ Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
² Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.
³ Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 342005.
⁴ Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
⁵ Department of Anaesthesia and Critical Care, ABVIMS and RML Hospital, New Delhi, 110001, India.
⁶ Department of Medicine, ABVIMS and RML Hospital, New Delhi, 110001, India.

Abstract

Purpose: Primary aim of this review was to compare the two treatment modalities-curettage and wide excision (WE)- of Giant cell tumours of distal radius along with the methods of reconstruction viz. arthrodesis (AD) and arthroplasty (AP), and determine which had a better outcome.

Methods: PubMed and Cochrane library databases were systematically searched using a well-defined search strategy by two independent reviewers. Inclusion/exclusion criteria were predetermined using the PICO format. MINORS tool was used to evaluate study quality. Recurrence rate (RR) was the chief oncological determinant whereas range of motion, grip strength, disability of arm, shoulder and hand (DASH) and musculoskeletal tumour society (MSTS) scores and complication rates were the functional outcome measures used.

Results: For the first part, a total of 11 articles (284 patients) were analysed. The second half- AP versus AD-included four studies (71 patients). Quantitative analysis revealed a significantly higher RR (Odds ratio (OR) 8.6 [95% CI, 3.4, 21.75]) with curettage. WE, on the other hand, was associated with a higher complication rate (OR 0.3[ 95% CI, 0.14, 0.62]) and lower grip strength (Standard Mean Difference (SMD) 18.08[95% CI, 13.78, 22.37]). Complication rates were also significantly higher with wrist AP (OR 6.36[ 95% CI, 1.72, 23.52]). Remaining functional parameters failed to show any significant difference between either group.

Conclusion: WE is the preferred surgical strategy in terms of lower RR and functionally equivalent results. In terms of the choice of reconstruction following WE, there is a trend towards higher patient satisfaction after wrist AD.

Keywords: Arthrodesis; Arthroplasty; Distal radius; Giant cell tumours; Intralesional curettage; Wide excision.

Publication types

Review