Combination of frozen autograft produced with liquid nitrogen and total hip replacement as a bone recycle reconstruction in pelvic osteosarcoma resection type 2: A case report

Introduction: Pelvic osteosarcoma remains a challenge for orthopedic surgeons to manage. However, recent advances giving various options to get a more effective reconstruction method. We present bone recycle reconstruction using a combination of frozen autograft and total hip replacement (THR) following extraarticular resection type II of pelvic osteosarcoma.Presentation of case: A 31-year-old female presented with pain in sitting and standing positions with no lump noted in the right hip joint for 11 months. Physical examination showed a palpable mass with indistinct margin in the inner groin area, with a limited range of motion. Histopathological examination confirmed small-cell osteosarcomaa. Extraarticular pelvic resection type 2 was performed followed by cryo-procedure using liquid nitrogen to produce frozen autograft. The graft was implanted and fixated with 3 reconstruction plates and screws, followed by THR. Postoperative plain radiographs showed the graft and implants were well-placed and fixated. There was no postoperative complication, local recurrence, or metastasis observed. The patient started to sit in the wheelchair without pain and walk using crutches.Discussion: Following resection of the hemi pelvic, various alternative reconstruction procedures such as pseudoarthrosis, arthrodesis, mega prostheses, massive allograft, and cryosurgery were attempted, but still dissatisfying which results in numerous complications. Expensive cost reconstruction makes it difficult to be performed in developing country like Indonesia.Conclusion: A combination of frozen autograft and THR following pelvic resection achieve a cost-effective and desirable outcome which gives a good result in short-term follow-up. It could be a promising option for managing oncology cases.