Liquid Nitrogen-treated Total Femur Autografts: A Viable Alternative to Total Femoral Replacement for Oncologic Applications?
Total femoral replacement (TFR) is a form of salvage arthroplasty that provides an alternative to amputation. A clear advantage is an immediate fixation allowing for early mobilization, particularly for oncologic conditions. However, complications are common and expenses are considerable for develop...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-07-01
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| Series: | Formosan Journal of Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/FJMD.FJMD_327 |
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| Summary: | Total femoral replacement (TFR) is a form of salvage arthroplasty that provides an alternative to amputation. A clear advantage is an immediate fixation allowing for early mobilization, particularly for oncologic conditions. However, complications are common and expenses are considerable for developing countries. For extensive pandiaphyseal as well as articular involvement, the entire tumor-bearing femur may be submerged in liquid nitrogen (LN) for subsequent use as a recycled autograft, facilitating the use of standard hip and constrained knee implants. We present two patients who have undergone this procedure, with favorable outcomes at 10 and 12 months, respectively. A 61-year-old male underwent unintended intralesional surgery for a pathologic fracture of the left femoral diaphysis, confirmed to be secondary to undifferentiated pleomorphic sarcoma at an outside institution. Intramedullary recurrence with skip metastasis to the ipsilateral proximal femur prompted consult. Wide resection and total femur freezing were performed. Reconstruction was completed using cemented bipolar hemiarthroplasty and a rotating hinged knee. At 10 months postsurgery, the patient achieved a Musculoskeletal Tumor Society (MSTS) score of 24, without evidence of local recurrence before demise from chemotherapy-related complications. A 75-year-old male sustained a pathologic hip fracture secondary to metastatic prostate cancer, with ipsilateral pandiaphyseal involvement of the left femur. No other distant metastases were noted on surveillance imaging. Total femur freezing was performed, followed by cemented bipolar hemiarthroplasty and a rotating hinged knee. At 12 months postsurgery, the patient has an MSTS score of 22 and is currently undergoing further systemic treatment. The use of LN-treated autografts is a promising alternative to TFR for a specific set of patients. A longer follow-up period is needed to ascertain its true benefits and advantages over TFR. |
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| ISSN: | 2210-7940 2210-7959 |