Knee joint preservation surgery in osteosarcoma using tumour-bearing bone treated with liquid nitrogen

Higuchi, Takashi; Yamamoto, Norio; Nishida, Hiroyuki; Hayashi, Katsuhiro; Takeuchi, Akihiko; Kimura, Hiroaki; Miwa, Shinji; Inatani, Hiroyuki; Shimozaki, Shingo; Kato, Takashi; Aoki, Yu; Abe, Kensaku; Taniguchi, Yuta; Tsuchiya, Hiroyuki

doi:10.1007/s00264-017-3499-x

Cited by 22 publications

(15 citation statements)

References 30 publications

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“…Currently, with the use of an extension shoe the patient claims to have little inconvenience in his daily life and we recognize no necessity for any further intervention. Functionally, the outcome of our case has not been as good as other cases in previous reports [12, 13], mainly resulting from the restricted range of motion of the knee joint. We assess its cause to be the delayed engraftment of the autograft, which meant he had to use a KAFO for as long as two years and the difficulty in providing effective physiotherapy due to his age and autism diagnosis.…”

Section: Discussioncontrasting

confidence: 87%

“…Irradiation, autoclaving, pasteurization and hypothermic procedures using liquid nitrogen have been introduced to kill tumor cells for recycling resected bone grafts. Frozen tumor devitalization with liquid nitrogen was first reported in 2005 and accumulating evidence has since supported its practicality [6, 7, 12, 13]. Advantages are the simplicity of the whole procedure, the provision of a perfect fit to the defect, preserving anchorage for soft tissue and ligamentous attachment, and restoring osteoinductive proteins within the bone.…”

Section: Discussionmentioning

confidence: 99%

“…Local recurrence in the treated bone has never been reported [6, 7, 12, 13]. Several retrospective studies on OS cases treated with joint sparing resection and frozen tumor-devitalized autografts have proved its applicability for juxtaarticular lesions, even in weight-bearing joints [6, 12, 13]. Favorable functional outcomes were obtained in these studies, with mean MSTS scores achieving 90% of the perfect score.…”

Section: Discussionmentioning

confidence: 99%

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Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

et al. 2019

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Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

et al. 2019

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“…The contents of JPLS include epiphysial-preservation tumor segment bone resection and bone defect repair, and because the used tumor segment bone has the advantages of lower rejection, low price, and good bone healing, we generally use inactivated tumor segment bone to repair bone defects.At present, the main modes of bone inactivation in the tumor segment are liquid nitrogen freezing [19], hypertonic saline [20] external radiotherapy [21], and alcohol [13]. Sung et al experimentally demonstrated that 95% of alcohol can completely kill tumor cells without interfering with osteogenesis and effectively preserves joint function [22].…”

Section: Discussionmentioning

confidence: 99%

Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Hou¹,

Bai²,

Xu³

et al. 2020

Preprint

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BackgroundWe compared the effects of two surgical procedures on limb function and quality of life in patients with osteosarcoma in the knee.MethodsThis retrospective study evaluated the postoperative outcomes of patients treated with JPLS and JPRS for osteosarcoma around the knee between November 2000 and December 2019. All patients were followed up for at least one year. Patients' lower extremity function, knee function, and quality of life were evaluated during follow-up using the MSTS score, IKDC score, and SF-36 score.ResultsAll 38 patients received a successful operation, and all incisions healed in one stage after surgery. At 12 months after the operation, the MSTS score in the prosthetic-replacement group (22.79±5.22) was lower than that in the joint-preservation group (27.05±1.62)(P=0.002). The IKDC score was lower in the prosthetic-replacement group (59.89±11.22) than in the joint-preservation group (76.84±9.42)( P <0.001). After 12 months, the SF-36 scores of physiological and social function in the joint-preserving group were higher than those in the prosthetic-replacement group (P <0.05), and there were no significant differences among the other indexes (P >0.05). Comparing the distribution of each item in the MSTS and IKDC scoring criteria between the joint-preservation and the prosthetic-replacement group revealed that the limb function, pain, satisfaction, support assistance, and the walking and gait of the joint preservation group were superior to those of the prosthetic-replacement group (P < 0.05). There was no significant difference in knee flexion between the two groups (P > 0.05). However, the joint preservation group was superior to the prosthesis replacement group in terms of pain, swelling, twisting, softening of the leg, movement downstairs, sitting up from a chair, kneeling, squatting, running straight forward, jumping up with the injured leg and landing, and quickly stopping or starting (P < 0.05).ConclusionCompared with joint-prosthesis replacement surgery, joint-preservation limb salvage leads to better joint function and quality of life. To improve the limb function and quality of life of patients with long-term survival osteosarcoma, joint-preservation limb salvage should be carried out according to the principles of Operation Indication, neoadjuvant and effective chemotherapy.

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“…Furthermore, for select patients, joint-sparing surgery is possible, allowing preservation of the joint structure in an effort to maintain normal limb function [ 2 ]. Several case series have reported the usefulness of sparing the knee joint in osteosarcoma in maintaining the function of the knee [ 3 – 5 ], whereas reports regarding wrist joint sparing surgery in osteosarcoma are few. This report presents a successful case of a distal radius osteosarcoma treated by en bloc resection and reconstructed with a tumor bearing autograft treated by liquid nitrogen.…”

Section: Introductionmentioning

confidence: 99%

Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report

et al. 2018

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BackgroundThe wrist joint is an extremely rare site for osteosarcoma. Joint structure preservation to maintain good limb function is well described in case of knee osteosarcoma, whereas it is not described in case of wrist joint osteosarcoma. In this report, we present the first case of joint preservation surgery to treat distal radius osteosarcoma using a tumor bearing autograft treated with liquid nitrogen.Case presentationA 46-year-old male presented with swelling and pain in the right wrist and was diagnosed with conventional osteosarcoma of the distal radius. The patient responded well to neoadjuvant chemotherapy and the tumor shrank remarkably. Wide tumor excision to preserve the radiocarpal joint and reconstruction with a tumor bearing frozen autograft were performed. Partial bone union was detected 3 months postoperatively and complete bone union was detected 9 months postoperatively. Following the surgery, there was immediate commencement of the range of motion (ROM) training in both the wrist and fingers. At the final postoperative follow-up of 41 months, the patient had normal ROM in the wrist, fingers, and forearms, with a score of 100% in the Musculoskeletal Tumor Society (MSTS) score and was disease free.ConclusionWe present the first case in which en bloc tumor excision with joint preservation of the wrist and reconstruction using a tumor bearing frozen autograft were performed. The surgery yielded excellent hand, wrist, and forearm function at the final follow-up.

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Knee joint preservation surgery in osteosarcoma using tumour-bearing bone treated with liquid nitrogen

Cited by 22 publications

References 30 publications

Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

Comparative Observation of Two Types of Limb Salvage Surgery on Limb Function and Quality of Life in Patients With Knee Joint Osteosarcoma

Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report

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