Abstract / Summary
Objectives: Reconstruction of the segmental defect created by wide tumor resection involving bone remains challenging. Liquid nitrogen–treated recycled autograft (LN2-RBG) is a widely used biological option, but its reconstructive outcomes (bone union and graft survival) have rarely been reported from multicenter settings with heterogeneous resources. We evaluated bone union and graft survival after LN2-RBG reconstruction. Material and Methods: This multicenter retrospective series included 36 consecutive patients undergoing wide resection and LN2-RBG reconstruction at five centers (surgery April 2020–February 2025). The primary outcomes were bone union and Kaplan–Meier graft survival, with failure defined as graft removal or amputation/ disarticulation from any cause; in a secondary sensitivity analysis, oncological removals were censored. Subgroup comparisons were exploratory and unadjusted for multiple comparisons. Results: Mean age was 27.5 years and mean follow-up 30.4 months (median 31.7). Union was analyzable in 29 of the 34 grafts with an osteotomy site: primary union was achieved in 26 (89.7%; 95% CI, 72.6–97.8) at a median of 9.0 months, and eventual union in 28 (96.6%; 95% CI, 82.2–99.9) after revision in two grafts; one nonunion persisted. Two-year graft survival was 71.5% (95% CI, 49.8–85.1) overall and 88.7% (95% CI, 68.1–96.3) when oncological removals were censored. Twenty-five of 36 patients (69.4%; 95% CI, 51.9–83.7) required at least one additional procedure (71 additional procedures in total). Deep infection occurred in 5.6%, skin necrosis in 8.3%, and graft resorption in 8.3%. Conclusion: In this small multicenter retrospective series, most evaluable grafts achieved primary union and nearly all achieved eventual union, but the reoperation burden was substantial. Two-year graft survival was 71.5% overall and 88.7% when oncological removals were censored. These findings are exploratory given the small cohort, the reduced denominator for union assessment and the limited follow-up; larger comparative studies with longer follow-up are needed.