Long-term Outcomes and Functional Limitations of Liquid Nitrogen-treated Autografts in Limb Salvage Surgery for Bone...

Liquid nitrogen-treated autografts are increasingly used in limb-salvage surgery because they preserve bone strength, maintain biological activity, and may enhance antitumor immunity. However, the true clinical performance of this technique remains controversial, particularly regarding graft survival and postoperative limb function.

We retrospectively analyzed 10 patients (11 limbs) who underwent reconstruction with liquid nitrogen-treated autografts. Graft survival was assessed using Kaplan-Meier analysis, and postoperative function was evaluated using the International Society of Limb Salvage (ISOLS) score. Potential risk factors were analyzed using univariate statistics.

At four years postoperatively, 72.7% of grafts remained available. Kaplan-Meier analysis demonstrated an impressively long mean graft survival of 156.5 months (95% confidence interval=96.1-217), underscoring the durability of this technique. No clinical variable - including age, diagnosis, fixation method, blood loss, or operative time - showed any significant association with graft failure. In contrast, graft length emerged as the sole parameter strongly linked to functional impairment, demonstrating a significant negative correlation with ISOLS scores.

The primary weakness of this technique lies not in graft survival but in functional decline associated with longer graft segments. These results emphasize the need for careful patient selection and strategic planning yet firmly support liquid nitrogen-treated autografts as a promising reconstructive option - especially in anatomical regions unsuitable for endoprosthesis replacement and in younger patients requiring joint-preserving strategies.