Video Gallery

Video Gallery

To View the Video

Joint Preservation Surgery Using Frozen Recycled Bone for Osteosarcoma Patients

February 10, 2018

Contributors: Kensaku Abe, MD; Yoshihiro Araki, MD; Katsuhiro Hayashi, MD; Takashi Higuchi, MD; Akihiko Takeuchi, MD; Yuta Taniguchi, MD; Norio Yamamoto, MD; Hiroyuki Tsuchiya, MD; Hiroyuki Tsuchiya, MD

Osteosarcomas are the most common primary malignant bone tumor that occurs in children and adolescents, and they frequently occur around the knee. In the past, amputation or joint disarticulation was the standard of care. Currently, more than 90% of osteosarcoma resections are limb-sparing procedures because of advancements in chemotherapeutic regimens and three-dimensional imaging studies, including CT and MRI. In addition, joint-sparing surgery is possible in select patients. To preserve the joint structure for good limb function in patients with osteosarcoma, we have been performing epiphyseal or metaphyseal osteotomy and biologic reconstruction via frozen autograft treated with liquid nitrogen. Several advantages are expected with the use of the freezing technique. This strategy involves simple surgical technique without specialized devices. A perfect fit is achieved because the managed bone is the patient’s own and bone strength is maintained postoperatively. Satisfactory bone union and revitalization are achieved as a result of good osteoinduction and osteoconduction because proteins and enzymes are preserved in the bone. In addition, tendons and ligaments easily attach to the managed bone. Recently, tumor immunity with the use of frozen tissue has gained attention. Based on these findings, the procedure maintains normal joint function and avoids complications associated with osteoarticular allografts and endoprostheses. This video introduces three surgical techniques for joint-sparing tumor resection and reconstruction surgery via frozen autograft treated with liquid nitrogen in patients with an osteosarcoma around the knee. These techniques include the free-freezing method, the free-freezing method with hemicortical resection, and the pedicle-freezing method. The free-freezing method is a safe procedure that involves liquid nitrogen treatment and intercalary resection of tumor-bearing bone. The preferred site is the distal femur. If the tumor is localized and contralateral bone can be preserved, the free-freezing method with hemicortical resection is preferred. The free-freezing method with hemicortical resection preserves more bone strength or normal structure and results in faster bone union or revitalization. The pedicle-freezing method involves an osteotomy of the proximal site, curettage of the tumor, and in situ management of the tumor-bearing bone via liquid nitrogen, continuing to the host bone. The proximal tibia, proximal femur, and proximal humerus are the preferred sites for this method. Implementation at these sites decreases the number of osteotomy sites, allowing for faster bone union. Compared with other reconstruction methods after tumor resection around the knee joint, frozen autograft may decrease the risk of fracture and nonunion and may be one of the most useful biologic reconstruction methods. Postoperative function after joint-preservation reconstruction via frozen autograft treated in liquid nitrogen was satisfactory. This procedure resulted in excellent function in patients with osteosarcoma around the knee.

Results for "Knee"