Cryosurgery in long bones; an experimental study of necrosis and revitalization in rabbits

Abstract

Cryosurgery is an established adjuvant treatment of bone tumors which reduces the local recurrence rate. In this study, cryosurgical experiments were carried out in rabbits to study the temperature field, the extent of necrosis, and the revitalization process in order to optimize treatment. Intramedullary freezing of long bones with a closed liquid nitrogen cryoprobe and three consecutive sessions induces osteonecrosis down to the -10 degrees C isotherm without compromising the soft tissues. The application of a tourniquet does not influence the thermodynamics. The revitalization process is distinguished into an osteogenic and a remodelling phase. In rabbits, there is an obvious periosteal osteogenesis starting from 1 week after operation and overlapping the remodelling phase, which starts between 3 and 5 weeks after operation. Two out of eight rabbits sustained a pathologic fracture within 3 weeks of cryosurgery. No pathologic fractures were encountered during the remodelling phase, probably because of the profuse periosteal bone apposition that added mechanical strength. In clinical practice, no profound periosteal bone apposition and a high risk for pathologic fractures during the remodelling phase were noted. Future research should focus on bone strength during the remodelling phase of cryosurgically treated long bones, to decide on the role of preventive osteosynthesis or postoperative restrictions. This animal model is not advised for these biomechanical experiments because of its profuse periosteal bone apposition.

Changes in morphology of long bone marrow tissue of rats submitted to cryotherapy with liquid nitrogen

“…This finding was consistent coma research by Keijser et al. 12 who analyzed the long bones of rabbits.…”

Oncological and functional results of cryosurgical therapy of enchondromas and chondrosarcomas grade 1

“…We observed that the regaining of the mechanical strength of bone after cryosurgery in goats reflects the same time period as in human bone [24]. Revascularization of biological grafts is reduced due to the necrosis following cryosurgery and consequently supplies less stability in the first post-operative months [23,25]. Intra-operative care can make a difference in complication incidence by adjusting the outline of the cortical window or the method of osteosynthesis [23].…”

The apparent critical isotherm for cryoinsult-induced osteonecrotic lesions in emu femoral heads

“…In previous work with this model, ON has been induced by liquid nitrogen cryoinsult (Conzemius et al, 2002;Reed et al, 2004). Although clinically not an etiologic factor, there is ample laboratory precedent for using cryoinsult to induce ON in dogs (Dailiana et al, 2001) and in rabbits (Keijser et al, 1999). Moreover, focal osteonecrotic lesions resulting from cryoinsult to the emu femoral head are very consistent with human disease pathophysiology (Goetz et al, 2005).…”