Knee joint reconstruction using liquid nitrogen recycled autograft prosthesis composite after wide resection for high-grade chondrosarcoma

Abstract

Background: Chondrosarcoma is the second most common malignant primary tumor of bone. The prognosis for chondrosarcoma depends mainly on its histologic grading and location. High-grade chondrosarcoma has higher a tendency to recur and metastasize. The standard treatment for chondrosarcoma is wide resection without adjuvant therapy. Numerous reconstructive options are available, varying from endoprostheses, biological reconstruction using allografts or osteoarticular allografts, and recycling of tumor-bearing segment.

Methods: We retrospectively reviewed seven patients with high-grade chondrosarcoma who underwent wide resection of the tumor mass and reconstruction using liquid nitrogen treated recycled autograft prosthesis composite. Evaluation was done for local recurrence, metastasis, graft-bone union, osteosynthesis, implant, or graft-related complications. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system.

Results: The mean follow-up period was 46 mo (range 24-65 mo). The average duration for graft union was 8.2 mo (range 7-10 mo). No local recurrence was detected in any patient. None of them had any metastatic deposits. One had a superficial wound infection. One had fulminant infection that required hip disarticulation. The mean Musculoskeletal Tumour Society functional score was 67.7% (range 60-78).

Conclusions: Recycled autograft prosthesis composite using liquid nitrogen is an oncologically safe and effective reconstructive option for the management of chondrosarcoma around the knee. It maintains knee function and restores the bone stock. It overcomes endoprosthesis-related problems, overcoming the obstacles of allograft in countries where it is not available or not socially or religiously acceptable.