Liquid nitrogen recycled autograft prosthesis composite reconstruction for osteosarcoma around the knee: review of 15 cases

Abstract

Background: Many technical and financial obstacles face surgeons when performing limb-salvage surgeries. Methods: We retrospectively studied 15 patients with osteosarcoma around the knee joint treated with limb salvage procedure in the form of wide resection, recycling the resected segment using liquid nitrogen followed by implantation of a hinged knee prosthesis and re-implantation of the autograft-prosthetic composite to the host bone by osteosynthesis, with mean follow-up duration of 66.53 mo. Results: The average duration until union of the graft was 7.73 mo (range, 4-13 mo). Implant failure occurred in one of 15 patients with resultant screw pull out for whom revision plating was done. Superficial wound infection occurred in one of 15 patients for whom surgical debridement was done. No prosthesis-related complications were detected until the final follow-up. Musculoskeletal Tumor Society (MSTS) scoring was applicable for 13 patients who were alive at the final follow-up period and was 73%. Eleven of 15 patients were disease free at last follow-up (average follow-up 66.5 mo). Conclusions: As far as we know no other research showed population study homogeneity regarding autograft prosthesis composite reconstruction using liquid nitrogen around the knee joint for the same pathology. Use of recycled autograft prosthesis composite is an option that eliminates disadvantages of both stand-alone endoprosthetic replacement and recycled tumor-bearing segment autografts while preserving the advantages of these techniques. The technique provides comparable survival rates to other techniques. It represents an alternative to the use of allograft when culturally unacceptable and saves about 50% of expected cost as compared to megaprosthesis reconstruction.

Biomechanical Analysis of Bone Graft Treated With Pasteurization or Cryotherapy Using Liquid Nitrogen: A Study Using Sheep Bone Model

“…Common treatment includes chemotherapy, radiotherapy, and limb salvage surgery [1]. Limb reconstruction of the resected bone using endoprosthesis, allograft, or autograft is among the options [7,21]. Autologous bone graft remains an option based on their biological component and availability in certain cases.…”

“…Treatment of osteosarcoma has improved over the years. Presently, primary chemotherapy, surgical intervention, and adjuvant chemotherapy are the most common treatment modalities for osteosarcoma [6,7]. Prior to the advent of chemotherapy, osteosarcoma was a fatal disease with patients surviving only a few months with metastasis at diagnosis.…”

“…However, it caused further physical and psychological trauma to the ill patient. With the introduction of various reconstructive surgery options such as autografts, allografts, and endoprosthesis, less destructive surgical methods were available, leading to a more fruitful life and better functional outcome, without compromising long-term survival rate [7,10]. Up to 95% of patients with osteosarcoma can be treated with limb-sparing surgery at major centres specializing in musculoskeletal oncology [11].…”

“…However, as each method eradicates the cells in different manners, further study needs to be performed to review the effect of each method on the structural viability of the graft. Several studies have highlighted the good outcome of sterilized autologous bone grafts [7,8,21]. However, to date, only a few studies have been done to determine the biomechanical properties of sterilized autologous bone grafts [11,24,25], and no study has been done to compare sterilized autologous bone grafts reconstructed with implants.…”

The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach

“…22,28,29 Tumour-bearing bone treated with liquid nitrogen was used as an autograft at various sites including proximal humerus, femur and distal fibula with good functional outcomes. 30,31 At one centre in Egypt, the liquid nitrogen treatment process cost just $80far lower in cost than an endoprosthesis. 31 Soft tissue reconstruction may incorporate the replacement of skin and soft tissue, neurovascular structures and muscle.…”