Cryotherapy in orthopaedic surgery

di Capanna • 2025 • dettagli prodotto

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DESCRIZIONE

The last thirty years have seen the introduction of new technical solutions that have revolutionized the surgical approach in various fields of orthopedic oncology.
In the treatment of benign tumors, the use of both local adjuvants (phenol, alcohol, liquid nitrogen, H2O2) and sophisticated instrumental techniques (cryotherapy with liquid nitrogen, radiofrequency, sterilization using laser beam or ultrasound) have made it possible to reclaim the internal edges of the bone cavity remaining at the curettage from any tumor microfoci and therefore to considerably reduce the risk of local recurrences.
Following the greater reliability of the method, there was a progressive increase in conservative indications (curettage vs resection). Interesting was the study of the interaction between curettage intervention and active drugs in giant cell tumors (Denosumab) which ultimately led to changes in the approach, timing and execution of the intervention.
Surgical experience gained with liquid nitrogen cryotherapy has also allowed us to appreciate and exploit other beneficial effects of this method (antihemorrhagic effect, “consolidating” effect in fluid-filled lesions at risk of intraoperative rupture). In the treatment of malignant tumors, direct immersion in liquid nitrogen allows for the complete sterilization of entire resected osteoarticular segments, allowing for subsequent reimplantation into the patient.
This procedure, which can be performed using various techniques, has advantages and disadvantages compared to other recycling methods (alcohol immersion, autoclave, irradiation).
In all of them, it is interesting to detect and study the antitumor immune stimulation effect exerted by the presence of devitalized tumor cells in situ.
Following the technological improvement of the instrumentation (dedicated probes) the ablative techniques from mainly intraoperative procedures were then carried out in a minimally invasive manner also percutaneously by exploiting the coupling with image techniques (ultrasound, CT scan, MRI) which allowed an accurate localization and monitoring of the procedure.
This has led to an expansion of indications from benign bone tumors to soft tumors and palliative treatment of bone metastases.
The recent introduction into clinical practice of sophisticated computer techniques currently allows the preoperative three-dimensional study of the lesion, the determination of the positioning and route of the probes, the calculation of the application times, as well as, in the application phase, the correct execution of the procedure by using virtual reality and the imaging guidance methods.
Based on vast experience (over 250 patients treated) In this text-atlas - accompanied by numerous clinical cases - we wanted to analyze the various aspects set out above.