Limb salvage in osteosarcoma using autoclaved tumor-bearing bone

Abstract

BackgroundTumor prostheses currently give the best short- and medium-term results for limb-salvage reconstruction procedures in the treatment of bone tumors. However, in developing countries, the cost of a tumor prosthesis is beyond the reach of much of the population. We report the use of autoclaved tumor-bearing bone in 10 patients, as an affordable alternative to the use of prostheses.MethodsThis is a case series of 10 patients (mean age 19 years) with osteosarcoma who were treated at our hospital from 1998 to 2008, and followed up for a mean of 35 months (range 14 to 8). The femur was involved in six cases, the humerus in three cases, and the ulna in one case. The mean length of the autoclaved bone was 150 mm (range 60–210).ResultsBone union occurred in seven patients over an mean duration of 12 months (range 8–17). Three patients had non-union. Two of these had associated implant failure, with one of them also developing chronic infection, and the third is still being followed up. Two other patients had local recurrence.ConclusionThe use of autoclaved tumor grafts provides an inexpensive limb-salvage option without sacrificing appropriate oncologic principles. A painless and stable limb is achievable, and the use of this technique can be further refined.

Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

“…Compared with other recycling autograft procedures, those in the current study had better or comparable union times and union rates ( Table 2). 5,6,[8][9][10]13,14,[19][20][21][22][23][24][25][26][27][28] It has been reported that the disadvantages of osteoarticular grafts are late osteoarthritis change and subchondral bone collapse, problems leading to tumor prosthesis revision or arthrodesis. The allograft-prosthesis composite was developed to prevent this problem, 4 and thesis survival rates, and complication rates for the current authors' procedures vs those of other procedures used for tumor reconstruction (allograft-prosthesis composite, extracorporeal autograftprosthesis composite, pasteurization autograft-prosthesis composite) is shown in Table 3.…”

“…4 Allografts are not available in some areas and have a high complication rate. There are many techniques used for recycling autografts, such as extracorporeal radiation, 5,6 pasteurization, 7,8 autoclaving, 9,10 and freezing. 11 The advantages of recycling autografts are good availability, no requirement of bone bank, biological reconstruction, no disease transmission, less immunological response, soft tissue and ligament attachment, and availability of a massive bone stock.…”

Clinical results of primary malignant musculoskeletal tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen

“…The limitations of tumor prosthesis are long‐term survival of the prosthesis and their high cost. Most patients in developing countries cannot afford this type of reconstruction and are treated by amputation even if they are technically eligible for limb salvage …”

The Recycling of Autoclaved Autografts in Mandibular Reconstruction: Case Report and Review of Literature

“…The success of eradicating tumour cells by autoclaving has also been endorsed by Pan [15] in the management of osteosarcomas.…”