What question did this study set out to answer?

To evaluate and compare the clinical, functional, and oncological outcomes of a hybrid liquid nitrogen-treated autograft combined with a megaprosthesis (LN-MP) against total femoral replacement (TFR) for extensive malignant femoral bone tumors.

August 14, 2026Archives of Orthopaedic and Trauma Surgery0 citationsOpen Access

Liquid nitrogen-treated autograft combined with megaprosthesis versus total femoral replacement for large-volume malignant femoral bone tumors: a comparative study

NSNguyen Tran Quang Sang NTNguyen Duc Trung LHLe Duc Huy

Key Points

To evaluate and compare the clinical, functional, and oncological outcomes of a hybrid liquid nitrogen-treated autograft combined with a megaprosthesis (LN-MP) against total femoral replacement (TFR) for extensive malignant femoral bone tumors.
Retrospective comparative cohort study of 28 patients aged 8–24 years treated between 2020 and 2024.
Patients underwent either hybrid LN-MP reconstruction (n = 10) or TFR (n = 18), with evaluations of perioperative metrics, Musculoskeletal Tumor Society (MSTS) functional scores, bone union, and disease recurrence.
LN-MP achieved significantly better functional outcomes (MSTS score 27.0 ± 2.1 vs. 24.4 ± 2.2, p = 0.014) along with shorter operative time and lower blood loss compared to TFR.
Continuous disease-free survival was higher in the LN-MP group than the TFR group (90% vs. 44%, p = 0.058), with lower recurrence rates (10% vs. 28%).
Bone union was achieved in 70% of LN-MP cases at a mean of 9 months, though longer graft length correlated with delayed union.

Abstract

Abstract 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.

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