In a first for South Africa, a Centurion-based surgeon has successfully performed a hip and limb salvage procedure using a liquid nitrogen dipping technique.
This 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.
Breakthrough procedure offers new options
The operation saved the leg of a 15-year-old boy with Ewing’s sarcoma, an aggressive bone cancer.
Standard treatment usually involves 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, 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 performed 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.
Working alongside Viljoen were assistants Dr Jadine du Plessis and Dr Herman Breet, anaesthetist Dr Bianca Brits, scrub nurse Gloria Kgwete and nursing assistants Leah Lekoane and Mahlatse Motheta.
The team treated the removed segment by immersing it in liquid nitrogen at -179°C to destroy cancer cells.
“The bone was then reimplanted, marking the first time this technique had been performed in South Africa. This kind of complex surgery is only possible with an exceptional team,” Viljoen said.
“Every person in that operating theatre played a crucial role in giving this young man his future back.”
Understanding Ewing’s sarcoma
Ewing’s sarcoma is the second most common bone tumour in children and adolescents, according to a recent study in The Lancet Oncology.
This aggressive cancer primarily affects individuals aged 10 to 20, with about 80% of cases diagnosed before the age of 20.
It most commonly arises 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 and long-term outlook
“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, Leonie de Lange.
“Follow-up tests will monitor how well the treated bone integrates. We’re cautiously optimistic about his progress,” said Viljoen.
“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 reimplantation – 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 reimplanted 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,” said Viljoen.
Viljoen previously headed the Tumour, Sepsis and Limb Reconstruction Unit at Steve Biko Academic Hospital.
‘Medical excellence’
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.
“Viljoen and his colleagues have added another chapter to South Africa’s legacy of medical excellence. But, this is about more than innovation,” said Erich Bock, managing director of Netcare’s hospital division.
“It’s proof that world-class orthopaedic care happens right here at home, offering hope to patients facing life-altering conditions such as Ewing’s sarcoma.”
