The long-term outcome following the use of frozen autograft treated with liquid nitrogen in the management of bone and soft-tissue sarcomas

Igarashi, Kentaro; Yamamoto, Norio; Shirai, Toshiharu; Hayashi, Katsuhiro; Nishida, Hiroyuki; Kimura, Hiroaki; Takeuchi, Akihiko; Tsuchiya, Hiroyuki

doi:10.1302/0301-620x.96b4.32629

Cited by 95 publications

(111 citation statements)

References 35 publications

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“…Two procedures involving freezing techniques-free freezing ( Figure 1A) and pedicle freezing ( Figure 1B)-were used depending on the location of the tumor. 11,13,14 Briefly, the tumor-bearing bone was frozen in liquid nitrogen for 20 minutes, thawed at room temperature for 15 minutes, and distilled in water for 10 minutes. Furthermore, the details of pedicle freezing were as follows.…”

Section: Methodsmentioning

confidence: 99%

“…11 They also modified the technique to produce pedicle freezing to maintain anatomical continuity on one side (Figure 1B), 13 and the long-term outcome has been satisfactory. 14 The purpose of this study was to determine the clinical and functional outcomes of the autograft-prosthesis composite technique in tumor surgery reconstruction using freezing techniques.…”

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confidence: 99%

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Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

Subhadrabandhu¹,

Takeuchi²,

Yamamoto³

et al. 2015

Orthopedics

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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.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

Subhadrabandhu¹,

Takeuchi²,

Yamamoto³

et al. 2015

Orthopedics

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“…The bulking area of the allograft had reshaped and continuous callus can be seen around the junction. and fibular autograft may also be applied to reconstruct the bone defect after segmental resection of long bones, 17,18 however, these methods may not be appropriate when the segment is large because the long time taken to achieve union might cause mechanical failure. Those patients who undergo prosthetic replacement might also encounter aseptic loosening with loss of bone stock, which would endanger the survival of a revision prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb

Guo

Yang

et al. 2015

The Bone & Joint Journal

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We determined the efficacy of a devitalised autograft (n = 13) and allograft (n = 16) cortical strut bone graft combined with long-stem endoprosthetic reconstruction in the treatment of massive tumours of the lower limb. A total of 29 patients (18 men:11 women, mean age 20.1 years (12 to 45) with a ratio of length of resection to that of the whole prosthesis of > 50% were treated between May 2003 and May 2012. The mean follow-up was 47 months (15 to 132). The stem of the prosthesis was introduced through bone graft struts filled with cement, then cemented into the residual bone. Bone healing was achieved in 23 patients (86%). The mean Musculoskeletal Tumour Society functional score was 85% (57 to 97). The five-year survival rate of the endoprostheses was 81% (95% confidence intervals 67.3 to 92.3). The mean length of devitalised autografts and allografts was 8.6 cm (5 to 15), which increased the ratio of the the length of the stem of the prosthesis to that of the whole length of the prosthesis from a theoretical 35% to an actual 55%. Cortical strut bone grafting and long-stem endoprosthetic reconstruction is an option for treating massive segmental defects following resection of a tumour in the lower limb. Patients can regain good function with a low incidence of aseptic loosening. The strut graft and the residual bone together serve as a satisfactory bony environment for a revision prosthesis, if required, once union is achieved.

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“…As alternative procedures, we used vascularized fibular grafts periosteum grafts or reimplantation of tumoral bone after it had been extracorporeally "sterilized" with cold or radiation [32][33][34][35][36][37] (Fig. 10).…”

Section: Complicationsmentioning

confidence: 99%

Biological Reconstruction in Bone Sarcomas: Lessons from Three Decades of Experience

San-Julián

Vázquez-García

2016

Orthopaedic Surgery

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Objective To review research on all patients treated by biological reconstruction after resection of bone sarcomas between 1987 and 2015 at our hospital. Methods One thousand one hundred and sixty‐seven cortical allografts and 166 cortical autografts were retrospectively analyzed. Radiological studies had been performed to determine the timing of consolidation of the grafts at both the metaphyseal and diaphyseal osteotomies. A prospective isotopic study with 99 Tc was done in order to evaluate the revascularization of allografts. Histological, immunohistochemistry and fluorescence techniques were used on retrieved allografts to evaluate their integration. Complications, functional results and possible relationships with human leukocyte antigen (HLA) compatibility, were also reviewed. Results The mean age of these patients with bone sarcomas was 19 years (range, 3–69 years). The mean length of cortical allografts was 19.5 cm (range, 4–42 cm) and of autografts 8 cm (range, 6–15 cm). The mean consolidation time of diaphyseal osteotomies was 16 months. The mean time to consolidation was 5 months for vascularized autografts and 12 months for non‐vascularized grafts. New bone formation was observed at the host bone–allograft junction. Complications included non‐union (16.2%), fractures (8.2%) and infections (11.8%). The incidence of complications was higher in the non‐compatible group; however, no significant relationship was found between HLA compatibility (or lack thereof) and the occurrence of complications. Conclusions Allografts are a good option for reconstruction after removal of larger tumors. It is necessary to take into account the mechanisms of incorporation and the measures that can be taken to reduce complications.

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The long-term outcome following the use of frozen autograft treated with liquid nitrogen in the management of bone and soft-tissue sarcomas

Cited by 95 publications

References 35 publications

Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors

Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb

Biological Reconstruction in Bone Sarcomas: Lessons from Three Decades of Experience

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