Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DING Hao , SHAO Xianhao , YANG Qiang , LI Ka ,  LI Jianmin ,  LI Zhenfeng

Department of Orthopedics, Qilu Hospital of Shandong University, Jinan Shandong, 250000, P. R. China;

Corresponding author：

LI Jianmin, Email: gkljm@163.com; LI Zhenfeng, Email: zhenfengli163@163.com

Keywords：

Distal radius; bone tumour; LARS ligament; three-dimensional printed prosthesis; hemicarpal reconstruction

DOI：

10.7507/1002-1892.202202086

Video：

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Objective To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. Methods The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. Results All 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=−10.761, P<0.001; t=−26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. Conclusion The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.

Citation： DING Hao, SHAO Xianhao, YANG Qiang, LI Ka, LI Jianmin, LI Zhenfeng. Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 822-827. doi: 10.7507/1002-1892.202202086 Copy

1.	Liu W, Wang B, Zhang S, et al. Wrist reconstruction after en bloc resection of bone tumors of the distal radius. Orthop Surg, 2021, 13(2): 376-383.
2.	Humail SM, Ghulam MK, Zaidi IH. Reconstruction of the distal radius with non-vascularised fibular graft after resection of giant cell tumour of bone. J Orthop Surg (Hong Kong), 2014, 22(3): 356-359.
3.	Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg, 2016, 8(2): 196-204.
4.	刘刚, 李佳琪, 黄俊琪, 等. 带血管蒂腓骨瓣移植重建CampanacciⅢ级桡骨远端骨巨细胞瘤切除术后桡腕关节的远期疗效. 中国修复重建外科杂志, 2020, 34(3): 352-356.
5.	Hu P, Zhao L, Zhang H, et al. Recurrence rates and risk factors for primary giant cell tumors around the knee: A multicentre retrospective study in China. Sci Rep, 2016, 6: 36332. doi: 10.1038/srep36332.
6.	Ji T, Tang X, Guo W. The use of Ligament Advanced Reinforcement System (LARS) in limb salvage surgery: a pilot clinical study. J Arthroplasty, 2013, 28(6): 892-894.
7.	Ji T, Tang X, Guo W. Enhancing soft-tissue reattachment in proximal humeral endoprosthetic reconstruction. J Orthop Surg (Hong Kong), 2014, 22(1): 100-103.
8.	Tang X, Guo W, Yang R, et al. Synthetic mesh improves shoulder function after intraarticular resection and prosthetic replacement of proximal humerus. Clin Orthop Relat Res, 2015, 473(4): 1464-1471.
9.	Du Z, Tang S, Yang R, et al. Use of an artificial ligament decreases hip dislocation and improves limb function after total femoral prosthetic replacement following femoral tumor resection. J Arthroplasty, 2018, 33(5): 1507-1514.
10.	Wang Y, Min Li, Lu M, et al. The functional outcomes and complications of different reconstruction methods for Giant cell tumor of the distal radius: comparison of Osteoarticular allograft and three-dimensional-printed prosthesis. BMC Musculoskelet Disord, 2020, 21(1): 69. doi: 10.1186/s12891-020-3084-0.
11.	Lu M, Min L, Xiao C, et al. Uncemented three-dimensional-printed prosthetic replacement for giant cell tumor of distal radius: a new design of prosthesis and surgical techniques. Cancer Manag Res, 2018, 10: 265-277.
12.	Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg (Am), 1994, 19(1): 143-154.
13.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
14.	Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg (Am), 1986, 68(5): 647-659.
15.	Innocenti M, Muratori F, Foschi L, et al. Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries? Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04165-8.
16.	毕郑钢, 潘琦, 付春江, 等. 吻合血管腓骨小头移植重建腕关节治疗桡骨远端骨巨细胞瘤. 中国修复重建外科杂志, 2010, 24(12): 1416-1418.
17.	Guder WK, Hardes J, Nottrott M, et al. Highly cancellous titanium alloy (TiAl₆V₄) surfaces on three-dimensionally printed, custom-made intercalary tibia prostheses: Promising short- to intermediate-term results. J Pers Med, 2021, 11(5): 351. doi: 10.3390/jpm11050351.
18.	Liu W, Shao Z, Rai S, et al. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol, 2020, 121(3): 570-577.
19.	Wiratnaya IGE, Budiartha IGBAM, Setiawan IGNY, et al. Hernia mesh prevent dislocation after wide excision and reconstruction of giant cell tumor distal radius. World J Orthop, 2017, 8(9): 741-746.

1. Liu W, Wang B, Zhang S, et al. Wrist reconstruction after en bloc resection of bone tumors of the distal radius. Orthop Surg, 2021, 13(2): 376-383.
2. Humail SM, Ghulam MK, Zaidi IH. Reconstruction of the distal radius with non-vascularised fibular graft after resection of giant cell tumour of bone. J Orthop Surg (Hong Kong), 2014, 22(3): 356-359.
3. Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg, 2016, 8(2): 196-204.
4. 刘刚, 李佳琪, 黄俊琪, 等. 带血管蒂腓骨瓣移植重建CampanacciⅢ级桡骨远端骨巨细胞瘤切除术后桡腕关节的远期疗效. 中国修复重建外科杂志, 2020, 34(3): 352-356.
5. Hu P, Zhao L, Zhang H, et al. Recurrence rates and risk factors for primary giant cell tumors around the knee: A multicentre retrospective study in China. Sci Rep, 2016, 6: 36332. doi: 10.1038/srep36332.
6. Ji T, Tang X, Guo W. The use of Ligament Advanced Reinforcement System (LARS) in limb salvage surgery: a pilot clinical study. J Arthroplasty, 2013, 28(6): 892-894.
7. Ji T, Tang X, Guo W. Enhancing soft-tissue reattachment in proximal humeral endoprosthetic reconstruction. J Orthop Surg (Hong Kong), 2014, 22(1): 100-103.
8. Tang X, Guo W, Yang R, et al. Synthetic mesh improves shoulder function after intraarticular resection and prosthetic replacement of proximal humerus. Clin Orthop Relat Res, 2015, 473(4): 1464-1471.
9. Du Z, Tang S, Yang R, et al. Use of an artificial ligament decreases hip dislocation and improves limb function after total femoral prosthetic replacement following femoral tumor resection. J Arthroplasty, 2018, 33(5): 1507-1514.
10. Wang Y, Min Li, Lu M, et al. The functional outcomes and complications of different reconstruction methods for Giant cell tumor of the distal radius: comparison of Osteoarticular allograft and three-dimensional-printed prosthesis. BMC Musculoskelet Disord, 2020, 21(1): 69. doi: 10.1186/s12891-020-3084-0.
11. Lu M, Min L, Xiao C, et al. Uncemented three-dimensional-printed prosthetic replacement for giant cell tumor of distal radius: a new design of prosthesis and surgical techniques. Cancer Manag Res, 2018, 10: 265-277.
12. Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg (Am), 1994, 19(1): 143-154.
13. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
14. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg (Am), 1986, 68(5): 647-659.
15. Innocenti M, Muratori F, Foschi L, et al. Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries? Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04165-8.
16. 毕郑钢, 潘琦, 付春江, 等. 吻合血管腓骨小头移植重建腕关节治疗桡骨远端骨巨细胞瘤. 中国修复重建外科杂志, 2010, 24(12): 1416-1418.
17. Guder WK, Hardes J, Nottrott M, et al. Highly cancellous titanium alloy (TiAl₆V₄) surfaces on three-dimensionally printed, custom-made intercalary tibia prostheses: Promising short- to intermediate-term results. J Pers Med, 2021, 11(5): 351. doi: 10.3390/jpm11050351.
18. Liu W, Shao Z, Rai S, et al. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol, 2020, 121(3): 570-577.
19. Wiratnaya IGE, Budiartha IGBAM, Setiawan IGNY, et al. Hernia mesh prevent dislocation after wide excision and reconstruction of giant cell tumor distal radius. World J Orthop, 2017, 8(9): 741-746.

Chinese Journal of Reparative and Reconstructive Surgery

Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection

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