Bone defect reconstruction with autologous bone inactivated with liquid nitrogen after resection of primary limb malignant tumors

Abstract

Surgical treatment of malignant bone tumors comprises tumor resection and reconstruction. The most commonly used reconstruction method is prosthesis replacement, which achieves good early function, but has a high long-term incidence of complications. Another reconstruction option is autologous bone replantation, which has the advantages of anatomical matching and no need for large bone bank support. Few studies have evaluated reconstruction with liquid nitrogen-inactivated autogenous bone. The present study aimed to evaluate the oncological results, bone healing results, complications, and indications of reconstruction with liquid nitrogen-inactivated autogenous bone grafts. The study population comprised 21 consecutive patients. The tumor site was the tibia in 9 cases, femur in 8, and humerus in 4. There were 37 osteotomy ends in total. After freezing and rewarming, the medullary cavity of the autogenous bone was filled with antibiotic bone cement. Seventeen patients received bilateral plate fixation, 2 received intramedullary nail and distal plate fixation, and 2 received single plate fixation. The average follow-up was 31 ± 6 months. Eighteen patients survived without tumors, and the 3-year survival rate was 80.4%. All cases had adequate surgical margins, but recurrence developed in 1 patient. Metastasis occurred in 3 patients, who all died of metastasis. Intraoperative inactivated bone fracture occurred in 1 patient, and screw breakage was found in 1 patient. Nonunion occurred at 1 humeral diaphysis osteotomy site, and 1 patient was lost to follow-up; the average healing time of the other 35 ends was 13 ± 6 months, and the bone healing rate was 97.2%. The average bone healing times in the metaphysis and diaphysis were 9 ± 3 months and 15 ± 6 months (P = .003). The average bone healing times in the upper and lower limbs were 16.6 ± 7.4 months and 12.3 ± 5.8 months (P = .020). The average Muscle and Skeletal Tumor Society score was 28 ± 3 (21–30) in the 18 survivors. Liquid nitrogen-inactivated autologous bone replantation for primary malignant limb tumor was safe and effective, as shown by the relatively low complication rate, high bone healing rate, and satisfactory postoperative function. This is a reliable biological reconstruction method for malignant bone tumors with specific site and bone destruction characteristics.

Reconstruction for bone tumours of the shoulder and humerus in children and adolescents

“…This approach suffers from problems in common with allograft including fracture, nonunion and infection. 53 , 54 Although there is less experience published for Masquelet-induced membrane restoration of intercalary defects for tumours, the method can be successful for defects over 20 cm. 55 That approach simplifies the primary resection with provisional stabilization but mandates a second substantial procedure.…”

Hip reconstruction with a combination of prosthesis and recycled autograft treated with liquid nitrogen in metastatic subtrochanteric fracture can improve quality of life: A case report

“…It is necessary to have enough bone stock to support prosthesis when it is indicated. Recently, tumour-bearing frozen autograft has more commonly employed as a bony resource in bone and joint defect reconstructive procedures, especially in resource-constrained environments [1] , [2] , [3] . There were reports favouring the use of liquid nitrogen to extracorporeally treat tumour-bearing bone instead of other methods such as irradiation, pasteurization and autoclaving due to its better osteoinductive ability [4] , [5] and preservation of compression strength of the treated bone [6] .…”

A comparison of cemented and cementless intra-neck curved stem use during hip-preserving reconstruction following massive femoral malignant tumor removal

“…The preservation of native hip joints can lower the risk of muscle damage, surgical disruption, and articular surface degeneration relative to the use of endoprosthetic hip joints, thereby improving the overall function of the lower extremities in treated patients. Alternative approaches to hip-preserving reconstruction (HPR) following MFMT resection include the use of inactivated autologous bone grafts ( 7 ), osteoarticular allografts ( 8 ), combined autografts and allofraft ( 9 , 10 ), and endoprostheses. Inactivated autologous bone grafted has the advantage of anatomical matching, biological reconstruction, relatively low cost, and no need for large bone bank support; however, inactivated bone fracture, infection, non-union, and internal fixation failure are the disadvantages of this technique ( 7 ).…”

“…Alternative approaches to hip-preserving reconstruction (HPR) following MFMT resection include the use of inactivated autologous bone grafts ( 7 ), osteoarticular allografts ( 8 ), combined autografts and allofraft ( 9 , 10 ), and endoprostheses. Inactivated autologous bone grafted has the advantage of anatomical matching, biological reconstruction, relatively low cost, and no need for large bone bank support; however, inactivated bone fracture, infection, non-union, and internal fixation failure are the disadvantages of this technique ( 7 ). Osteoarticular allograft can result in the biological reconstruction of bone defects and preserve host bone stock without donor site morbidity ( 11 ).…”