Abstract
BackgroundLimb salvage surgery is a treatment of choice for sarcomas of the extremities. One of the options in skeletal reconstruction after tumour resection is by using a recycled bone autograft. The present accepted methods of recycling bone autografts include autoclaving, pasteurization and irradiation. At the moment there is lack of studies that compare the effectiveness of various sterilization methods used for recycling bone autografts and their effects in terms of bone incorporation. This study was performed to determine the effects of different methods of sterilization on bone autografts in rabbit by radiological, biomechanical and histopathological evaluations.MethodsFresh rabbit cortical bone is harvested from the tibial diaphysis and sterilized extracorporeally by pasteurization (n = 6), autoclaving (n = 6), irradiation (n = 6) and normal saline as control group (n = 6). The cortical bones were immediately reimplanted after the sterilization process. The subsequent process of graft incorporation was examined over a period of 12 weeks by serial radiographs, biomechanical and histopathological evaluations. Statistical analysis (ANOVA) was performed on these results. Significance level (α) and power (β) were set to 0.05 and 0.90, respectively.ResultsRadiographic analysis showed that irradiation group has higher score in bony union compared to other sterilization groups (p = 0.041). ANOVA analysis of ‘failure stress’, ‘modulus’ and ‘strain to failure’ demonstrated no significant differences (p = 0.389) between treated and untreated specimens under mechanical loading. In macroscopic histopathological analysis, the irradiated group has the highest percentage of bony union (91.7 percent). However in microscopic analysis of union, the pasteurization group has significantly higher score (p = 0.041) in callus formation, osteocytes percentage and bone marrow cellularity at the end of the study indicating good union potential.ConclusionsThis experimental study shown that both irradiation and pasteurization techniques have more favourable outcome in terms of bony union based on radiographic and histopathological evaluations. Autoclaving has the worst outcome. These results indicate that extracorporeal irradiation or pasteurization of bone autografts, are viable option for recycling bone autografts. However, pasteurization has the best overall outcomes because of its osteocytes preservation and bone marrow cellularity.
Highlights
Limb salvage surgery is a treatment of choice for sarcomas of the extremities
Up to 95% of patients with osteosarcoma can be treated with limb-sparing surgery at major centres specializing in musculoskeletal oncology, and producing a dramatic improvement of long-term survival rate in 60-80% of patients with localized disease since the 1970s after the introduction of intensive multiagent adjuvant chemotherapy [1,2]
The present study focuses on three different methods of sterilization that are commonly used for treatment of bone autografts before reimplantation at our center
Summary
Limb salvage surgery is a treatment of choice for sarcomas of the extremities. One of the options in skeletal reconstruction after tumour resection is by using a recycled bone autograft. Up to 95% of patients with osteosarcoma can be treated with limb-sparing surgery at major centres specializing in musculoskeletal oncology, and producing a dramatic improvement of long-term survival rate in 60-80% of patients with localized disease since the 1970s after the introduction of intensive multiagent adjuvant chemotherapy [1,2]. This is mainly due to a well—coordinated multidisciplinary approach involving different specialties. Neoadjuvant and adjuvant chemotherapy has been proven to improve the survival rate of patient with nonmetastatic and metastatic osteosarcoma
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