Comparable outcomes of recycled autografts and allografts for reconstructions in patients with high-grade osteosarcoma.

PURPOSE: This retrospective, single-centre study compares the clinical and radiographic outcomes of limb reconstruction using recycled autografts to that using allografts. METHODS: Patients with histopathologically verified high-grade osteosarcoma treated with wide bone resection and limb reconstruction using allografts or recycled autografts from January 1998 through December 2012 were retrospectively screened for enrolment eligibility. The final study cohort included 255 patients (allograft, 91; recycled autograft, 164). Data regarding post-operative complications, salvage treatment, and graft survival were collected. A modified International Society of Limb Salvage classification system was used to evaluate the radiographic findings. RESULTS: The time to graft-host union did not differ significantly between the two graft types. Patients receiving recycled autografts had fewer complications compared than did those receiving allografts (recycled autografts vs. allograft: structural failure, 4.3 vs. 13.2%; late infection, 2.4 vs. 7.7%; all p < 0.05). Complications occurred most frequently during the first three years after surgery, and the majority were manageable. The five year limb survival rate did not differ significantly between the two graft types (91.3 vs. 94.0%; p = 0.752). No local oncological recurrence was observed within the recycled autografts. CONCLUSION: Recycled autografts and allografts are feasible options for biological limb reconstructions in terms of complications and graft survival after wide resection of osteosarcoma.

Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report.

BACKGROUND: The wrist joint is an extremely rare site for osteosarcoma. Joint structure preservation to maintain good limb function is well described in case of knee osteosarcoma, whereas it is not described in case of wrist joint osteosarcoma. In this report, we present the first case of joint preservation surgery to treat distal radius osteosarcoma using a tumor bearing autograft treated with liquid nitrogen. CASE PRESENTATION: A 46-year-old male presented with swelling and pain in the right wrist and was diagnosed with conventional osteosarcoma of the distal radius. The patient responded well to neoadjuvant chemotherapy and the tumor shrank remarkably. Wide tumor excision to preserve the radiocarpal joint and reconstruction with a tumor bearing frozen autograft were performed. Partial bone union was detected 3 months postoperatively and complete bone union was detected 9 months postoperatively. Following the surgery, there was immediate commencement of the range of motion (ROM) training in both the wrist and fingers. At the final postoperative follow-up of 41 months, the patient had normal ROM in the wrist, fingers, and forearms, with a score of 100% in the Musculoskeletal Tumor Society (MSTS) score and was disease free. CONCLUSION: We present the first case in which en bloc tumor excision with joint preservation of the wrist and reconstruction using a tumor bearing frozen autograft were performed. The surgery yielded excellent hand, wrist, and forearm function at the final follow-up.

Does liquid nitrogen recycled autograft for treatment of bone sarcoma impact local recurrence rate? A systematic review.

The gold standard treatment for primary bone sarcomas has been surgical resection with wide margins. However, there is no consensus regarding an optimal method for limb salvage reconstruction. In 2005, a technique for recycling resected bone after intraoperative treatment with liquid nitrogen was described. This technique has been reported to have a spectrum of advantages; nonetheless, acceptance for routine use has been limited, primarily for fear of local recurrence. A systematic search of the literature using PubMed and Google Scholar was performed. Full-text articles published between 2008 and 2023 were included if the study presented sufficient information regarding patients with a diagnosis of a primary bone sarcoma of the limbs or pelvis who had undergone reconstruction with liquid nitrogen recycled autografts. Sixteen studies that included 286 patients met criteria for analyses. Local recurrence occurred in 25 patients (8.7 %) during the first 4 years following limb salvage reconstruction using recycled autografts for treatment of primary bone sarcomas, which compares favorably to the 15-30 % local recurrence rates reported for patients undergoing limb salvage reconstruction using artificial implants. Systematic synthesis of the current evidence regarding local recurrence rates following use of the liquid nitrogen recycled autograft technique for limb salvage reconstruction after bone sarcoma resection suggests a favorable comparison to other limb salvage reconstruction options. As such, this technique warrants further consideration as a viable option for indicated patients based on relative advantages regarding costs, availability, and biologic and surgical reconstruction benefits.

Optimal design of bone tumor ablation device based on radio frequency heating using Taguchi method.

This study investigated the optimal design of a radio-frequency (RF) bone tumor ablation device to achieve uniform heating. In a previous study, we confirmed the feasibility of this device, which could heat all regions of the bone to 70 °C or higher and maintain this temperature for more than 30 min. However, the temperature in each part was non-uniform. To address this issue, the shape of the electrode must be modified to create a uniform electric field. The design of the electrode was optimized to reduce temperature deviations. It is difficult to analytically model the relationship between the shape of the electrode and the electric field. The electrode's design factors were fine-tuned using the Taguchi method, a robust design of experiment approach. The primary objective in this optimization was to maximize the signal-to-noise ratio for temperature in each component, aiming for higher values. After four trials, the signal-to-noise ratio increased in comparison with the initial modified shape from 68.3 to 98.6. The experiment was conducted using an experimental device fabricated using the optimal design factors. In comparison to the previous experiment, the temperature standard deviation per part over time decreased from 10.56 °C 4.28 °C. The experimental results demonstrated the validity of the proposed optimal design approach. In the future, the proposed method can be used to optimize the design factors when a product is advanced to develop a device that can be applied to the human body.

Limb Salvage Using Liquid Nitrogen-Treated Tumour-Bearing Autograft: A Single Institutional Experience of 10 Patients.

BACKGROUND: Many reconstruction methods have evolved to offer limb salvage surgery (LSS) to patients with musculoskeletal sarcomas. It can be achieved using endoprosthesis or biological reconstruction methods like allograft or autograft or a combination of both. In carefully selected patients, resected bone can be recycled and reimplanted after sterilisation using methods like irradiation, autoclaving, pasteurisation or liquid nitrogen. METHODS: From 2010 to 2016, 10 patients with primary musculoskeletal sarcoma underwent limb salvage surgery (LSS) by wide resection of the tumour and reconstruction using recycled autograft treated with liquid nitrogen. Intercalary resection was carried out in six patients and intra-articular in four. The resected bone was dipped in liquid nitrogen for 25 min, thawed at room temperature for 15 min followed by dipping in vancomycin-mixed saline for 10 min. The recycled bone was re-implanted into its original site and stabilised with internal fixation. RESULTS: At a mean follow-up period of 39.6 months (range 6-97 months), all patients had a good function (mean functional score of 80%) with no evidence of local recurrence in the re-implanted bone or otherwise. Union was achieved at 15 of the 16 osteotomy sites with a mean union time of 5.2 months (range 4-7 months) without any additional surgical interventions. In none of the patient, augmentation with vascularised/non-vascularised fibula was done. No complication like fracture of the autograft, implant failure or deep/superficial infection was reported in any patient. CONCLUSION: Recycled tumour-bearing autograft after treatment with liquid nitrogen is an anatomical, cost-effective, relatively simpler and reliable technique for reconstruction of bone defect after resection in selective primary musculoskeletal sarcoma patients.