Which is the best method of sterilization of tumour bone for reimplantation? a biomechanical and histopathological study

Abstract

IntroductionSterilization and re-usage of tumour bone for reconstruction after tumour resection is now gaining popularity in the East. This recycle tumour bone needs to be sterilized in order to eradicate the tumour cells before re-implantation for limb salvage procedures. The effect of some of these treatments on the integrity and sterility of the bone after treatment has been published but there has yet been a direct comparison between the various methods of sterilization to determine the one method that gives the best tumour kill without compromising the bone's structural integrity.MethodThis study was performed to evaluate the effect of several sterilization methods on the mechanical behavior of human cortical bone graft and histopathology evaluation of tumour bone samples after being processed with 4 different methods of sterilization. Fresh human cortical tumour bone is harvested from the diaphyseal region of the tumour bone were sterilized by autoclave (n =10); boiling (n =10); pasteurization (n =10); and irradiation (n =10). There were also 10 control specimens that did not receive any form of sterilization treatment. The biomechanical test conducted were stress to failure, modulus and strain to failure, which were determined from axial compression testing. Statistical analysis (ANOVA) was performed on these results. Significance level (α) and power (β) were set to 0.05 and 0.90, respectively.ResultsANOVA analysis of 'failure stress', 'modulus' and 'strain to failure' demonstrated significant differences (p < 0.05) between treated cortical bone and untreated specimens under mechanical loading.'Stress to failure' was significantly reduced in boiled, autoclaved and irradiated cortical bone samples (p < 0.05). 'Modulus' detected significant differences in the boiled, autoclaved and pasteurization specimens compared to controls (p < 0.05). 'Strain to failure' was reduced by irradiation (p < 0.05) but not by the other three methods of treatments.Histopathology study revealed no viable tumour cell in any of four types of treatment group compared to the untreated control group.ConclusionsSterilization of cortical bone sample by pasteurization and to a lesser extent, irradiation does not significantly alter the mechanical properties when compared with untreated samples. Mechanical properties degrade with the use of high temperature for sterilization (boiling). All methods of sterilization gave rise to 100 percent tumour kill.

En bloc resection, intraoperative extracorporeal irradiation and re‑implantation of involved bone for the treatment of limb malignancies

“…Recycling of the resected bone segment is a beneficial alternative method that is more economic than the prosthetic devices, as well as durable and more psychological accepted because of its biological nature, and may be achieved by irradiation, freezing or heating (17)(18)(19). Various methods of sterilization of tumor-bearing bone have been described.…”

“…Various methods of sterilization of tumor-bearing bone have been described. Autoclaving and boiling lead to the complete destruction of bone cells, but have the disadvantage of leading to considerable decrease in the biological and biomechanical properties of the graft compared to pasteurization and irradiation, causing severe injury to the collagen matrix and bone proteins (17). Liquid nitrogen as an effective and available cryogenic agent may be used for either tissue preservation or destruction.…”

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

“…2). For the three patients who underwent wide resection and recycled tumor bone implantation, the resected tumor bone was immersed in preheated 10% saline at 65°for 20 minutes after eliminating the tumor tissue [9,38,40]. Table 1.…”

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

“…Singh et al [12] evaluated the effect of 4 different sterilization methods on the status of tumour cells in limb salvage surgery for bony sarcomas. Their autoclaving cycle was 135°C for 12-15 min at a pressure of twenty-nine pounds per square inch.…”

“…Singh and co-workers [12] compared the effect of autoclaving, irradiation and pasteurisation. They found that there was very little alteration in the mechanical properties after irradiation and pasteurisation as compared to sterilisation by boiling which showed degradation of mechanical properties.…”