Archives of orthopaedic and trauma surgery · 2026
Liquid nitrogen-treated autograft combined with megaprosthesis versus total femoral replacement for large-volume malignant femoral bone tumors: a comparative study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Sang Nguyen Tran Quang, Trung Nguyen Duc, Huy Le Duc, Phuc Luu Huu, Thang Vu Duc, Anh Luong Nhat, Hung Le The, Hien Tran Thi Thu, Hai Tran Tuyet Thanh, Vinh Duong Quang, Cong Tran Van, Dat Nguyen Quoc, Quang Dang Minh, Thanh Tran Duc, Dung Tran Trung
Аннотация
BACKGROUND: Limb-salvage surgery for extensive femoral osteosarcoma presents major reconstructive challenges. Conventional options such as total femoral replacement (TFR) and long-segment biological reconstructions are associated with significant complications. We evaluated the clinical outcomes of a novel hybrid approach combining a liquid nitrogen-treated autograft with a megaprosthesis (LN-MP) and compared them with those of TFR.
MATERIALS AND METHODS: This retrospective study included 28 patients (range 8-24 years old) with malignant femoral bone tumors treated between 2020 and 2024. Patients underwent either LN-MP (n = 10) or TFR (n = 18). Perioperative outcomes, functional results (Musculoskeletal Tumor Society score-MSTS), bone union, oncological control, and survival were analyzed.
RESULTS: LN-MP demonstrated better functional outcomes (MSTS 27.0 ± 2.1 vs. 24.4 ± 2.2, p = 0.014), shorter operative time, and lower blood loss compared with TFR. Length of stay and follow-up duration were comparable. Continuous disease-free survival was higher in the LN-MP group (90% vs. 44%, p = 0.058), with lower recurrence (10% vs. 28%). Bone union was achieved in 70% of LN-MP cases at a mean of 9 months, with longer graft length associated with delayed union.
CONCLUSIONS: LN-MP reconstruction may serve as a joint-preserving alternative to total femoral replacement for patients with extensive malignant femoral tumors. In this preliminary series, LN-MP was associated with favorable functional outcomes, satisfactory graft-host bone union, and acceptable oncological results. Given the retrospective design, limited sample size, and short follow-up duration, further studies with larger cohorts and longer follow-up are required to define the role of LN-MP among contemporary limb-salvage reconstructive strategies.
LEVEL OF EVIDENCE: Therapeutic, Level III: retrospective comparative cohort study.
MATERIALS AND METHODS: This retrospective study included 28 patients (range 8-24 years old) with malignant femoral bone tumors treated between 2020 and 2024. Patients underwent either LN-MP (n = 10) or TFR (n = 18). Perioperative outcomes, functional results (Musculoskeletal Tumor Society score-MSTS), bone union, oncological control, and survival were analyzed.
RESULTS: LN-MP demonstrated better functional outcomes (MSTS 27.0 ± 2.1 vs. 24.4 ± 2.2, p = 0.014), shorter operative time, and lower blood loss compared with TFR. Length of stay and follow-up duration were comparable. Continuous disease-free survival was higher in the LN-MP group (90% vs. 44%, p = 0.058), with lower recurrence (10% vs. 28%). Bone union was achieved in 70% of LN-MP cases at a mean of 9 months, with longer graft length associated with delayed union.
CONCLUSIONS: LN-MP reconstruction may serve as a joint-preserving alternative to total femoral replacement for patients with extensive malignant femoral tumors. In this preliminary series, LN-MP was associated with favorable functional outcomes, satisfactory graft-host bone union, and acceptable oncological results. Given the retrospective design, limited sample size, and short follow-up duration, further studies with larger cohorts and longer follow-up are required to define the role of LN-MP among contemporary limb-salvage reconstructive strategies.
LEVEL OF EVIDENCE: Therapeutic, Level III: retrospective comparative cohort study.