In a South African first, a Centurion surgeon has performed a hip and limb salvage procedure using a liquid nitrogen dipping technique, saving the leg of a 15-year-old boy with Ewing’s sarcoma, an aggressive bone cancer, reports The Citizen.
The pioneering approach, performed at Netcare Unitas Hospital in Tshwane, could significantly expand treatment options for certain patients with orthopaedic cancers, particularly those who would typically require removal of the affected bone and its replacement with a prosthesis.
In this particular case, standard treatment would usually involve removing the cancerous section of bone and replacing it with either a large metal prosthesis or the patient’s own bone after irradiation to destroy cancer cells.
“When I explained that conventional surgery meant no more contact sports for this young sportsman, I saw the devastation in his eyes – and in his father’s. That’s when I knew we had to try something different,” said Dr Jaco Viljoen, an orthopaedic surgeon with a special interest in orthopaedic oncology.
“I’d been prepared for this exact scenario for 10 years. When I mentioned there might be another way – a chance he could play sport again – their faces lit up.”
Complex surgery by specialist team
During the four-and-a-half-hour procedure, Viljoen led a skilled team in removing a 24cm section of the teenager’s femur (thigh bone) where the cancer had developed.
They treated the removed segment by immersing it in liquid nitrogen at -179°C to destroy cancer cells.
“The bone was then re-implanted – the first time this technique had been performed in South Africa,” Viljoen said. “Every person in that operating theatre played a crucial role in giving this young man his future back.”
Ewing’s sarcoma
Ewing’s sarcoma is the second most common bone tumour in children and adolescents, usually affecting youngsters aged between 10 and 20, with about 80% of cases diagnosed before 20.
It most commonly occurs in the long bones of the legs and arms, as well as in the pelvis and chest wall, accounting for 10% to 15% of all bone cancers. Without treatment, the disease progresses rapidly, making early intervention critical.
Promising recovery
A day after surgery, the patient was alert and showed good neurovascular function in the affected leg – promising early signs. He even managed a few assisted steps with his physiotherapist. Follow-up tests would monitor how well the treated bone integrates, Viljoen told The Citizen.
“This technique marks a significant departure from standard treatment. The traditional approach would have involved the complete removal of the affected bone, followed by a complex prosthetic reconstruction of the hip, which often limits long-term mobility and rules out a return to contact sports.”
A second alternative – irradiating the patient’s bone before re-implantation – can compromise bone integrity and increase the risk of non-union, often requiring further surgery.
“For this keen young rugby and cricket player, preserving his natural bone and joint function was a critical consideration,” he added.
Technique may reshape future treatment
The ideal solution stemmed from a Japanese technique Viljoen had been holding in reserve. The sophisticated procedure, although developed by specialists in Japan more than a decade ago, is rarely performed worldwide – particularly not in patients with Ewing’s sarcoma – and requires exceptional precision.
The extreme cold destroys cancerous tumours while preserving the bone’s architecture, allowing it to heal naturally once re-implanted and secured with surgical pins.
“We’ve effectively preserved his bone and hip joint. His own bone will regenerate and integrate with the surrounding tissue. For a young person, that’s game-changing, as his leg can continue to develop normally. By preserving his natural anatomy, this procedure offers him the possibility of returning to full activity once healed.
“This technique offers hope of avoiding amputation in other clinically appropriate patients,” added Viljoen.
Viljoen previously headed the Tumour, Sepsis and Limb Reconstruction Unit at Steve Biko Academic Hospital.
A graduate of the University of Pretoria, he completed his orthopaedic specialisation in 2015 and now practises privately at Netcare Unitas Hospital and Netcare Montana Hospital.
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