Patient-specific instrument can achieve same accuracy with less resection time than navigation assistance in periacetabular pelvic tumor surgery: a cadaveric study

  • Kwok-Chuen Wong
  • Kwan-Yik Sze
  • Irene Oi-Ling Wong
  • Chung-Ming Wong
  • Shekhar-Madhukar KumtaEmail author
Original Article



Inaccurate resection in pelvic tumors can result in compromised margins with increase local recurrence. Navigation-assisted and patient-specific instrument (PSI) techniques have recently been reported in assisting pelvic tumor surgery with the tendency of improving surgical accuracy. We examined and compared the accuracy of transferring a virtual pelvic resection plan to actual surgery using navigation-assisted or PSI technique in a cadaver study.


We performed CT scan in twelve cadaveric bodies including whole pelvic bones. Either supraacetabular or partial acetabular resection was virtually planned in a hemipelvis using engineering software. The virtual resection plan was transferred to a CT-based navigation system or was used for design and fabrication of PSI. Pelvic resections were performed using navigation assistance in six cadavers and PSI in another six. Post-resection images were co-registered with preoperative planning for comparative analysis of resection accuracy in the two techniques.


The mean average deviation error from the planned resection was no different (\(p=0.19\)) for the navigation and the PSI groups: 1.9 versus 1.4 mm, respectively. The mean time required for the bone resection was greater (\(p=0.0006\)) for the navigation group than for the PSI group: 16.2 versus 1.1 min, respectively.


In simulated periacetabular pelvic tumor resections, PSI technique enabled surgeons to reproduce the virtual surgical plan with similar accuracy but with less bone resection time when compared with navigation assistance. Further studies are required to investigate the clinical benefits of PSI technique in pelvic tumor surgery.


Navigation assistance Patient-specific instruments Periacetabular pelvic tumors Surgical accuracy 



We thank Ms. Janice Tsui (Project Assistant, Technology Applications in BioMed Unit, Industrial center, the Hong Kong Polytechnic University, Hong Kong SAR, China) for her assistance in design and fabrication of PSI and the evaluation of the resection accuracy by the navigation and PSI techniques. We thank Mr. Sun Wong (Project Engineer, Stryker China Limited) and Mr. Watson Chan (Sales Manager, Stryker China Limited) for operating the navigation machine in the cadaveric study.

Compliance with ethical standards

Conflict of interest

The institutions of one or more authors (SMK and CMW) have received funding from the Research Grants Council of the Hong Kong Special Administration Region (RGC Grant: CUHK 465412) for the work in the manuscript. Other authors (WKC, SKY and WIOL) declare no conflict of interest.

Ethical standards

This article does not contain any studies with human participants performed by any of the authors. No informed consent is needed as the study does not contain human participants.


  1. 1.
    Jeys L, Matharu GS, Nandra RS, Grimer RJ (2013) Can computer navigation-assisted surgery reduce the risk of an intralesional margin and reduce the rate of local recurrence in patients with a tumour of the pelvis or sacrum? Bone Joint J 95-B(10):1417–1424Google Scholar
  2. 2.
    Fuchs B, Hoekzema N, Larson DR, Inwards CY, Sim FH (2009) Osteosarcoma of the pelvis: outcome analysis of surgical treatment. Clin Orthop Relat Res 467:510–518PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Ozaki T, Flege S, Kevric M, Lindner N, Maas R, Delling G, Schwarz R, von Hochstetter AR, Salzer-Kuntschik M, Berdel WE, Jürgens H, Exner GU, Reichardt P, Mayer-Steinacker R, Ewerbeck V, Kotz R, Winkelmann W, Bielack SS (2003) Osteosarcoma of the pelvis: experience of the cooperative osteosarcoma study group. J Clin Oncol 21:334–341CrossRefPubMedGoogle Scholar
  4. 4.
    Cartiaux O, Docquier PL, Paul L, Francq BG, Cornu OH, Delloye C, Raucent B, Dehez B, Banse X (2008) Surgical inaccuracy of tumor resection and reconstruction within the pelvis: an experimental study. Acta Orthop 79:695–702CrossRefPubMedGoogle Scholar
  5. 5.
    Aponte-Tinao LA, Ritacco LE, Ayerza MA, Muscolo DL, Farfalli GL (2013) Multiplanar osteotomies guided by navigation in chondrosarcoma of the knee. Orthopedics 36(3):e325–e330CrossRefPubMedGoogle Scholar
  6. 6.
    Cho HS, Oh JH, Han I, Kim HS (2012) The outcomes of navigation-assisted bone tumour surgery: minimum three-year follow-up. J Bone Joint Surg (Br) 94–B:1414–1420CrossRefGoogle Scholar
  7. 7.
    Ieguchi M, Hoshi M, Takada J, Hidaka N, Nakamura H (2012) Navigation-assisted surgery for bone and soft tissue tumors with bony extension. Clin Orthop Relat Res 470:275–283PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Li J, Wang Z, Guo Z, Chen GJ, Yang M, Pei GX (2012) Irregular osteotomy in limb salvage for juxta-articular osteosarcoma under computer-assisted navigation. J Surg Oncol 106(4):411–416CrossRefPubMedGoogle Scholar
  9. 9.
    So TY, Lam YL, Mak KL (2010) Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique. Clin Orthop Relat Res 468:2985–2991PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Wong KC, Kumta SM, Chiu KH, Antonio GE, Unwin P, Leung KS (2007) Precision tumour resection and reconstruction using image-guided computer navigation. J Bone Joint Surg (Br) 89–B:943–947CrossRefGoogle Scholar
  11. 11.
    Wong KC, Kumta SM (2013) Computer-assisted tumor surgery in malignant bone tumors. Clin Orthop Relat Res 471:750–761PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Lu S, Xu YQ, Lu WW, Ni GX, Li YB, Shi JH, Li DP, Chen GP, Chen YB, Zhang YZ (2009) A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976) 34(26):E959–E966CrossRefGoogle Scholar
  13. 13.
    Mac-Thiong JM, Labelle H, Rooze M, Feipel V, Aubin CE (2003) Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine. Eur Spine J 12:542–547PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Miyake J, Murase T, Moritomo H, Sugamoto K, Yoshikawa H (2011) Distal radius osteotomy with volar locking plates based on computer simulation. Clin Orthop Relat Res 469(6):1766–1773PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K (2008) Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 90(11):2375–2389CrossRefPubMedGoogle Scholar
  16. 16.
    Lionberger DR, Crocker CL, Chen V (2014) Patient Specific Instrumentation. J Arthroplasty 29(9):1699–1704CrossRefPubMedGoogle Scholar
  17. 17.
    Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470(1):99–107PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Bellanova L, Paul L, Docquier PL (2013) Surgical guides (patient specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction. Sarcoma 2013:787653PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Cartiaux O, Paul L, Francq BG, Banse X, Docquier PL (2014) Improved accuracy with 3D planning and patient-specific instruments during simulated pelvic bone tumor surgery. Ann Biomed Eng 42(1):13–205CrossRefGoogle Scholar
  20. 20.
    Wong KC, Kumta SM, Sze KY, Wong CM (2012) Use of a patient specific CAD/CAM surgical jig in extremity bone tumor resection and custom prosthetic reconstruction. Comput Aided Surg 17(6):284–293CrossRefPubMedGoogle Scholar
  21. 21.
    Wong KC, Kumta SM, Leung KS, Ng KW, Ng EW, Lee KS (2010) Integration of CAD/CAM planning into computer assisted orthopaedic surgery. Comput Aided Surg 15:65–74CrossRefPubMedGoogle Scholar
  22. 22.
    Khan FA, Lipman JD, Pearle AD, Boland PJ, Healey JH (2013) Surgical technique: computer-generated custom jigs improve accuracy of wide resection of bone tumors. Clin Orthop Relat Res 471(6):2007–2016PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Cartiaux O, Banse X, Paul L, Francq BG, Aubin CÉ, Docquier PL (2013) Computer-assisted planning and navigation improves cutting accuracy during simulated bone tumor surgery of the pelvis. Comput Aided Surg 18(1–2):19–26CrossRefPubMedGoogle Scholar
  24. 24.
    Ritacco LE, Milano FE, Farfalli GL, Ayerza MA, Muscolo DL, Aponte-Tinao LA (2013) Accuracy of 3-D planning and navigation in bone tumor resection. Orthopedics 36(7):e942–e950CrossRefPubMedGoogle Scholar
  25. 25.
    Wong KC, Kumta SM (2014) Use of computer navigation in orthopedic oncology. Curr Surg Rep 2:47 eCollection 2014. ReviewPubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© CARS 2015

Authors and Affiliations

  • Kwok-Chuen Wong
    • 1
  • Kwan-Yik Sze
    • 2
  • Irene Oi-Ling Wong
    • 3
  • Chung-Ming Wong
    • 4
  • Shekhar-Madhukar Kumta
    • 5
    Email author
  1. 1.Department of Orthopaedics and TraumatologyPrince of Wales HospitalShatinHong Kong
  2. 2.Technology Applications in Biomed Unit, Industrial CentreThe Hong Kong Polytechnic UniversityHung HomHong Kong
  3. 3.Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
  4. 4.Head of Rapid Prototyping and Tooling Unit, Industrial CentreThe Hong Kong Polytechnic UniversityHung HomHong Kong
  5. 5.Department of Orthopaedics and TraumatologyPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong

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