Joint-preserving surgery is performed in select patients with bone sarcomas of extremities and allows patients to retain the native joint with better joint function. However, recurrences may relate to achieving adequate margins and there is frequently little room for error in tumors close to the joint surface. Further, the tumor margin on preoperative CT and/or MR images is difficult to transpose to the actual extent of tumor in the bone in the operating room.
We therefore determined whether joint-preserving tumor surgery could be performed accurately under image-guided computer navigation and determined local recurrences, function, and complications.
We retrospectively studied eight patients with bone sarcoma of extremities treated surgically by navigation with fused CT-MR images. We assessed the accuracy of resection in six patients by comparing the cross sections at the resection plane with complementary prosthesis templates. Mean age was 17 years (range, 6–46 years). Minimum followup was 25 months (mean, 41 months; range, 25–60 months).
The achieved resection was accurate, with a difference of 2 mm or less in any dimension compared to that planned in patients with custom prostheses. We noted no local recurrence at latest followup. The mean Musculoskeletal Tumor Society score was 29 (range, 28–30). There were no complications related to navigation planning and procedures. There was no failure of fixation at the remaining epiphysis.
In selected patients, the computer-assisted approach facilitates precise planning and execution of joint-preserving tumor resection and reconstruction. Further followup assessment in a larger study population is required in these patients.
Level of Evidence
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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We thank Mr. Eric Wai-Kin Ng and Mr. Keith Kam-Shing Lee (ACAOS-ITAV team, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong) for setup of the navigation system and documentation of operative procedures. We also thank Mr. Sudha Shunmugam, the design team, and Dr. Paul Unwin (Stanmore Implants Worldwide Ltd) for design and manufacture of the CAD custom prostheses. We acknowledge the great assistance of Mr. Rock Hu and Ms. Yukin Zhao (Bio-Medical Engineering, Materialise China, Shanghai, China) in using the MIMICS® software.
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Wong, K.C., Kumta, S.M. Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation. Clin Orthop Relat Res 471, 762–773 (2013) doi:10.1007/s11999-012-2536-8
- Bone Resection
- Bone Sarcoma
- Computer Navigation
- Resection Plane
- MSTS Score