Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

Abstract

Several methods are available using an endoprosthesis or biological reconstruction for malignant bone tumors. Methods that use allograft-prosthesis composites have shown promising results. In 1999, the authors developed a method of reconstruction that uses a tumor-bearing autograft treated with liquid nitrogen. This technique was modified to produce a pedicle frozen autograft to maintain anatomical continuity on one side. In this study, the results of bone reconstructions using frozen autograft-prosthesis composites were retrospectively evaluated. The demographic data, histological records, surgical procedures, functional scores, and complications of 22 patients who had bone sarcoma or metastasis and at least 2 years of follow-up were reviewed. There were 19 patients with primary bone sarcoma and 3 with bone metastasis. Average age was 36 years (range, 9-73 years), and mean follow-up was 63 months (range, 24-176 months). Reconstructions were performed on 10 proximal femurs, 5 distal femurs, 4 proximal tibias, 1 proximal humerus, 1 proximal radius, and 1 hemipelvis. There were 12 pedicle-freezing and 10 free-freezing procedures. Union rate was 90% (9/10), and average union time was 9.5 months. Average Musculoskeletal Tumor Society score was 89.3%. Complications included 1 fracture, 2 infections, 3 soft tissue recurrences, and 1 posterior interosseous nerve palsy. The authors concluded that the frozen autograft-prosthesis composite demonstrated excellent Musculoskeletal Tumor Society scores, a low complication rate, and a good union rate and was superior when used with the pedicle-freezing technique.

Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

“…This could account for some of the observed recurrence benefit of microwave-induced hyperthermia in our series. To the best of our knowledge, there were no local recurrences reported when amputation was performed, which is the same as in our study [5, 15, 18, 28, 29]. …”

Clinical course of grafted cartilage in osteoarticular frozen autografts for reconstruction after resection of malignant bone and soft-tissue tumor involving an epiphysis

“…The clinical outcome of frozen autografts has been reported, and frozen autografts achieved a composite graft leading to a stable result compared with an osteoarticular graft for reconstruction of an epiphysis [9] , [10] . However, there are still good cases of osteoarticular grafts where the grafted cartilage survived for a relatively long period with good function.…”

Intraoperative Extracorporeal Irradiation and Frozen Treatment on Tumor-bearing Autografts Show Equivalent Outcomes for Biologic Reconstruction

“…In addition, a tendon/ligament-bearing bone graft is preferable for soft tissue reconstruction [15] and lower risk of transmitted diseases [7]. Several methods have been developed to eradicate tumor cells before implantation, such as pasteurization [1,4], extracorporeal irradiation [7,17], freezing [10,15,19,21], and autoclaving [22].…”

“…However, an intrafreezing graft fracture could compromise some advantages. Studies evaluating the use of extracorporeal irradiation [7,9,13,17] or frozen autografts [10,15,19] and acceptable outcomes in terms of complications and graft failure-free survivorship have been reported. Owing to the unexpected events in surgical practice, we did not randomize the selection of either technique for patients receiving autografts.…”