Limb Salvage with Low and Heat Treated Autobone

Shin, Kyoo Ho

Abstract

Limb salvage surgery for treatment of malignant bone tumors is an acceptable alternative to amputation in most patients as marked improvement has been achieved in diagnostic imaging, neoadjuvant chemotherapy, and operative techniques. There are several options for limb salvage: endoprosthesis, allograft, treated autobone, etc and each has its own advantages and disadvantages. Prosthetic replacement is an option for limb salvage surgery, but loosening, breakage, and wear are encountered during long-term follow up. Allografts require a large scale bone bank system, and there are concerns of immunologic responses, transmission of disease, religious and social circumstance, and high complication rate. Low heat treated autobone graft are reasonable option of treated autobone. Multiple studies and clinical application of heat treated bone proved the superiority of low heat treated bone(pasteurization, heating at 60 degrees ... to 65 degrees ... for 30 minutes) over other methods of heat treatment such as autoclaving or boiling. Low heat treatment has a lethal effect on malignant cells while preserving sufficient biomechanical strength and bone inducing property. Low heat treatment showed satisfactory results of bone remodeling and union, function, complication (fracture, infection and bone resorption). Several studies suggest that low heat treatment(pasteurization) may be superior to other cell-lethal treatment for autologous bone graft used for limb salvage surgery.