Effects of liquid nitrogen treatment on the proliferation ofosteosarcoma and the biomechanical properties of normal bone

doi:10.1007/s10776-002-0626-3

Journal of Orthopaedic Science

Volume 8, Issue 3, May 2003, Pages 374-380

https://doi.org/10.1007/s10776-002-0626-3 Get rights and content

Abstract

To overcome problems of autografts for reconstructionin the presence of malignant bone and soft tissuetumors, we devised a method for treating autografts thatutilizes the hypothermic effect of liquid nitrogen. Wemeasured temperature changes inside the bone at eachcondition and established a one-cycle liquid nitrogen protocolthat included 20 min in liquid nitrogen, 15 min in room air, and15min in physiological saline. The proliferation potential ofthe tumor cells treated with the liquid nitrogen method wasexamined by means of bromodeoxyuridine (BrdU) immunostaining.Tumor proliferation potential in vivo was examined innude mice. Based on the results we concluded that the tumorcells died out as a result of the liquid nitrogen method. Regardingcompression strength there was no significant differencebetween intact bone and liquid nitrogen-treated bone,whereas the strength of the autoclaved bone was decreased.Scanning electron microscopic examination of the fracturesurface of the autoclaved bone after the compression testshowed an irregular, uneven surface, whereas that of theliquid nitrogen-treated bone was smooth and fine-grained.This might be one of the reasons for the discrepancy in compressionstrength.

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Autografts offer the advantage of precise dimensions required for reconstruction as well as preservation of muscle attachments, but application is limited to nonosteolytic bone tumors [11–13]. Furthermore, procedures for devitalization of the tumor bearing bone segment such as extracorporeal irradiation [13], freezing [11,14] or autoclaving [13] alter bone morphology. Hence the capacity for biological remodeling is diminished, which may affect the graft-host bone incorporation [11,13].
Limb-preserving surgery in young children suffering malignant bone tumor of the femur is challenging due to the specific anatomical conditions. Extendable tumor endoprostheses are often oversized, while custom-made endoprostheses do not provide the intraoperatively required variability regarding reconstruction length. Allo- and autograft replacements, on the other hand, show high complication and revision rates. We report a novel reconstructive procedure after resection of malignant bone tumors of the femur in young children, and present our preliminary results of this technique.
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Recently, tumour-bearing frozen autograft has more commonly employed as a bony resource in bone and joint defect reconstructive procedures, especially in resource-constrained environments [1–3]. There were reports favouring the use of liquid nitrogen to extracorporeally treat tumour-bearing bone instead of other methods such as irradiation, pasteurization and autoclaving due to its better osteoinductive ability [4,5] and preservation of compression strength of the treated bone [6]. Moreover, the liquid nitrogen-treated autograft (LNTA) was reported to have low recurrence rate of tumour in long term outcomes [3,7–9].
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Limb salvage surgery for pathological proximal hip fracture due to metastasis is always challenging. The goal of treatment must include pain-free affected limb with enough function to improve the QoL during the patient's end stage. Several reports on using frozen recycled autograft showed good results regarding anatomical matching, bone healing, function, and cost-effectiveness. We combined prosthesis and LNTA to manage the patient with end stage lung cancer and pathological proximal hip fracture. The patient was satisfied with the 6-month postoperative results before being deceased due to the widespread metastases.
Composite of LNTA and prosthesis might be a good alternative for treating metastatic fracture due to its anatomical matching, preservation of bone stock and cost-effectiveness where allograft and megaprosthesis are not available.
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Orthopaedic ScienceEffects of liquid nitrogen treatment on the proliferation ofosteosarcoma and the biomechanical properties of normal bone

Abstract

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Am J Surg

Am J Surg

Aneurysmal bone cysts: a clinicopathologic study of 66 cases

Cancer

Cryogenic surgery of the basal ganglia

JAMA

Pasteurized intercalary autogenous bone graft: radiographic and scintigraphic features

Skeletal Radiol

A system of staging musculoskeletal neoplasms

Clin Orthop

Freezing bone without excision

JAMA

Cryosurgery techniques, morphology and immun-ology: an overview

Low Temp Med

Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur: medium to long-term results

J Bone Joint Surg Am

Current status of cryopre- servation of pancreatic islets

Low Temp Med

An experimental study regarding regeneration of the ligament and ligament-bone junction in the frozen allografts

J Juzen Med Soc

Repositioning of craniofacial tumorous bone after autoclaving

Scand J Plast Reconstr Surg Hand Surg

Orthopaedic Science
Effects of liquid nitrogen treatment on the proliferation ofosteosarcoma and the biomechanical properties of normal bone