Survival and functional outcomes following the use of an isolated, liquid nitrogen-treated, devitalized autograft after femoral ıntercalary resection in patients with bone sarcomas

Abstract

This study aimed to evaluate the clinical and functional outcomes of femoral diaphyseal sarcoma resections reconstructed using liquid nitrogen-treated tumor-bearing autografts filled with antibiotic-impregnated polymethylmethacrylate (PMMA), locked intramedullary nailing with proximal and distal derotation plating, and docking-site grafting. Method: Between 2004 and 2023, nine patients who underwent femoral diaphyseal resection for osteosarcoma (n=5), Ewing's sarcoma (n=3), and small cell sarcoma (n=1) were retrospectively reviewed. In all cases, tumor-bearing bone segments were devitalized using a standardized liquid nitrogen protocol, followed by reimplantation with reconstruction-type intramedullary nailing without incorporating a vascularized graft. A detailed evaluation of postoperative clinical (complications), radiological (union time), and functional outcomes was conducted. Functional outcomes were assessed using the Musculoskeletal Tumor Society Score (MSTS). Results: The study included nine patients with a mean age of 18.6 years (range, 14-35 years), of whom four were male and five were female. The mean follow-up period was 6.55 years (range: 4-19). The mean tumor size was 14.4 cm (range, 11-20 cm). Timely union occurred in six patients (66.6%), while two experienced delayed union and one had nonunion, all of which ultimately healed with or without reintervention. No local or systemic infections, graft fractures, or implant failure were observed. At the final follow-up, five patients were disease-free, three were alive with the disease, and one died of the disease. The mean MSTS score was 89.5 (range, 84-96). Conclusions: Liquid nitrogen-treated autografts offer a safe, cost-effective, and biologically favorable reconstruction option for femoral diaphyseal sarcomas, particularly in young patients with adequate soft tissue coverage. When applied with a standardized technique and careful augmentation, this method results in favorable union rates and long-term functional outcomes.