Liquid nitrogen recycled autograft prosthesis composite reconstruction for osteosarcoma around the knee: review of 15 cases

Abstract

Background:

Many technical and financial obstacles face surgeons when performing limb-salvage surgeries.

Methods:

We retrospectively studied 15 patients with osteosarcoma around the knee joint treated with limb salvage procedure in the form of wide resection, recycling the resected segment using liquid nitrogen followed by implantation of a hinged knee prosthesis and re-implantation of the autograft-prosthetic composite to the host bone by osteosynthesis, with mean follow-up duration of 66.53 mo.

Results:

The average duration until union of the graft was 7.73 mo (range, 4-13 mo). Implant failure occurred in one of 15 patients with resultant screw pull out for whom revision plating was done. Superficial wound infection occurred in one of 15 patients for whom surgical debridement was done. No prosthesis-related complications were detected until the final follow-up. Musculoskeletal Tumor Society (MSTS) scoring was applicable for 13 patients who were alive at the final follow-up period and was 73%. Eleven of 15 patients were disease free at last follow-up (average follow-up 66.5 mo).

Conclusions:

As far as we know no other research showed population study homogeneity regarding autograft prosthesis composite reconstruction using liquid nitrogen around the knee joint for the same pathology. Use of recycled autograft prosthesis composite is an option that eliminates disadvantages of both stand-alone endoprosthetic replacement and recycled tumor-bearing segment autografts while preserving the advantages of these techniques. The technique provides comparable survival rates to other techniques. It represents an alternative to the use of allograft when culturally unacceptable and saves about 50% of expected cost as compared to megaprosthesis reconstruction.