Total elbow replacement for giant-cell tumor of bone after denosumab treatment: a case report

Abstract Giant-cell tumor of bone (GCTB) is an intermediate type of primary bone tumor characterized by locally aggressive growth with metastatic potential. GCTB contains two groups of cells: osteoclast-like giant cells and mononuclear (stromal) cells. Stromal cells express receptor activator of nuclear factor kappa B ligand (RANKL) and activate osteoclasts via the RANKL-RANK pathway. Denosumab, the monoclonal human antibody against RANK ligand, is indicated in the treatment of locally advanced tumors to facilitate tumor resection and decrease the risk of local recurrence. We present a case report of a missed case of a pathological fracture of the proximal ulna. The patient underwent intralesional osteosynthesis without resection, which led to tumor progression. The neoadjuvant use of denosumab caused the downstaging of the tumor, which facilitated complete tumor resection. Total elbow replacement restored the bone defect and offered an excellent functional outcome in combination with attachment tube soft tissue reconstruction. The patient has a full function of his extremity and is disease-free at three years follow-up.