• sarcoma
• bone tumour
• adiuvant therapy
• oncological surgery
• orthopaedics
• tumour ablation
• cryosurgery
• palliative treatment
• cryotherapy

Since ages cryotherapy has been used to treat several medical conditions. In the twentieth century, after XXII, liquid nitrogen become easily available and started to be used as cryogenic source for surgical purposes. Marcove has been a very pioneer in using liquid nitrogen for tumour ablation in the field of orthopaedic surgery. Since the sixties he developed a technique of freezing the bone tumour interface directly pouring liquid nitrogen into the cavity made from tumour manual curettage. That method has been used for decades and has still its indications. Thanks to technological progress has been fine tuned in years cryoprobes capable to carry and use the cryogenic power of argon gas, thanks to the Joule Thompson effect. That made possible for orthopaedic surgeons to use cryotherapy in different applications that spread the way of treating musculoskeletal tumours beyond the adjuvant application of nitrogen into cavities produced by curettage. In this paper is presented our twenty-year experience in this field. In a period between 2000 and 2021, 235 patients affected by musculoskeletal tumours has been treated with cryotherapy, at the Oncological Orthopaedic Division at the Florence CTO Hospital or the II Orthopaedic Clinic at the Cisanello University Hospital in Pisa. Five different indications for cryotherapy will be presented, along with five different operative techniques. A review of the available literature on this field, published from 1968 to 2021, will be presented and the results will be compared to what we have reached. Present applications and alternative techniques will be discussed. Cryotherapy is a valuable therapeutical strategy in orthopaedic oncology, with the aim of combine oncological safety and anatomic preservation. Very promising fields of study are combination therapy of cryosurgery and immune-stimulation, along with chemotherapy or radiotherapy, aimed at taking advantage of the immune-modulating effects operated by cryotherapy, as well as new strategies of surgical planning and navigation, based on combining, with dedicated software, 3D modelling and virtual reality.