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.
Sang et al. (2026) studied this question.