scholarly journals Complex joint-preserving bone tumor resection and reconstruction using computer navigation and 3D-printed patient-specific guides: A technical note of three cases

2021 ◽  
Vol 29 ◽  
pp. 152-162
Author(s):  
Kwok Chuen Wong ◽  
Louis Kwan Yik Sze ◽  
Shekhar Madhukar Kumta
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Computer Navigation ◽  
Technical Note ◽  
Patient Specific ◽  
3D Printed ◽  
Bone Tumor Resection ◽  
Complex Joint

scholarly journals The Accuracy of Three-Dimensional Planned Bone Tumor Resection Using Patient-Specific Instrument

2020 ◽  
Vol Volume 12 ◽  
pp. 6533-6540
Author(s):  
Daniel A Müller ◽  
Yannik Stutz ◽  
Lazaros Vlachopoulos ◽  
Mazda Farshad ◽  
Philipp Fürnstahl
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Patient Specific ◽  
Specific Instrument ◽  
Bone Tumor Resection

Improving Cutting Path on Custom 3D-Printed Surgical Guides for Bone-Tumor Resection

2019 ◽  
Author(s):  
Carlos G. Helguero ◽  
Juan Castro ◽  
César Ochoa ◽  
Fausto Maldonado ◽  
Emilio A. Ramírez ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Element Analysis ◽  
Surgical Guides ◽  
Orthopedic Oncology ◽  
3D Printed ◽  
Bone Tumor Resection ◽  
High Level ◽  
Cutting Path

Abstract Custom three-dimensional (3D) printed guides are being used in the operative room as an aid to surgeons for increasing the accuracy of their cutting and resection techniques. In terms of bone-tumor resection, the cutting path printed in the custom jig is significantly important for two main purposes: first, the required fit for the implant that will replace the resected bone section and, second, the interaction between the remaining, healthy bone and the new implant in terms of forces, stresses and deformation. Bone tumor resection has posed a challenge in orthopedic oncology, specifically due to a high level of difficulty in performing a limb-sparing surgery with negative margins on the remaining bone. A straight cutting path is usually used in clinical procedures due to the type of tooling available inside the operative room. 3D printed cutting path guides offer the possibility to evolve from a straight to a different path, e.g. a tapered path, and overcome fitting problems during surgery. This work investigates the current straight cutting path used for typical bone tumor resection and compares it to a proposed tapered cutting path in terms of both implant fitting and stress analysis. Finite element analysis software is used to simulate a compression force exerted over the femur bone. Different taper cut angles are studied and results are reported to obtain an ideal angle for resection. Results are presented to evidence the need to evolve from the current resection technique in order to minimize the number of revision surgeries and for a better quality of life of patients under this type of surgical procedure.

scholarly journals Assessment of Resection Margins in Bone Tumor Surgery

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Corentin Malherbe ◽  
Bernard Crutzen ◽  
Jean Schrooyen ◽  
Giovanni Caruso ◽  
Frédéric Lecouvet ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Patient Specific ◽  
Resection Margins ◽  
Limb Salvage Surgery ◽  
Tumor Surgery ◽  
Surgical Guide ◽  
Median Error ◽  
Bone Tumor Resection

Limb salvage surgery is now the preferred procedure for bone tumor surgery. To decrease the risk of local recurrence, it is crucial to obtain adequate resection margins. The obtained margins must be evaluated postoperatively because they influence what treatment is given subsequently when margins are not adequate (e.g., surgical revision and radiotherapy). The study aims to evaluate margin assessment of tumor specimen by MRI compared to conventional histology (to establish the viability of using MRI) and assess the accuracy of a patient-specific instrument when narrow margins were aimed. The resection margins in 12 consecutive patients that were operated on for bone tumor resection were prospectively analyzed using three methods: MRI of the resection specimen, macroscopic evaluation of specimen slices, and microscopic pathological evaluation. The assessments were qualitative (R0, R1, and R2) and quantitative (distance in mm). MRI, macroscopic, and microscopic margins generated similar results for both the qualitative (all resections were R0) and quantitative assessments. The median error in safe margins was 2 mm with a surgical guide (PSI) and 5 mm without a surgical guide. Local recurrences were not detected after a mean follow-up period of 3.7 years (range, 2.1–5 years); however, four patients died during the study. In conclusion, MRI is a valuable tool for assessing safe margins. When specimens are not available for pathological assessment (e.g., extracorporeally irradiated autograft or autoclaved autograft), MRI could be used to evaluate margins. In particular, when tumor volume is high, MRI could also help to focus the pathological examination on areas of concern.

scholarly journals Computer-Assisted Planning and Patient-Specific Instruments for Bone Tumor Resection within the Pelvis: A Series of 11 Patients

Sarcoma ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
François Gouin ◽  
Laurent Paul ◽  
Guillaume Anthony Odri ◽  
Olivier Cartiaux
Keyword(s):  
Computed Tomography ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Pelvic Bone ◽  
Patient Specific ◽  
Computer Assisted ◽  
Minimal Distance ◽  
Location Accuracy ◽  
Patient Specific Instruments ◽  
Bone Tumor Resection

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins.

scholarly journals Margin quality and local recurrence with Patient specific instruments for bone tumor resection

10.29007/p23s ◽  
2018 ◽  
Author(s):  
Laurent Paul ◽  
Thomas Schubert ◽  
Robin Evrard ◽  
Pierre-Louis Docquier
Keyword(s):  
Local Recurrence ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Patient Specific ◽  
Medical Outcomes ◽  
Surgical Time ◽  
Oncologic Surgery ◽  
Physical Support ◽  
Patient Specific Instruments ◽  
Bone Tumor Resection

Bone tumor resection and subsequent reconstruction remains challenging for the surgeon. Obtaining adequate margins is mandatory to decrease the risk of local recurrence. Improving surgical margins quality without excessive resection, reducing surgical time and increasing the quality of the reconstruction are the main goals of today’s research in bone tumor surgical management. With the outstanding improvements in imaging and computerized planning, it is now a standard. However, surgical accuracy is essential in orthopaedic oncologic surgery (Grimmer 2005).Patient specific instruments (PSI) may greatly improve the surgeon's ability to achieve the targeted resection. Thanks to its physical support, PSI can physically guide the blade yielding to a better control over the cutting process (Wong, 2014). Surgical time might significantly be reduced as well when compared to conventional method or navigated procedure. Finally, reconstruction may gain in rapidity and quality especially when allograft is the preferred solution as PSI can be designed as well for allograft cutting (Bellanova, 2013).Since 2011, PSI have systematically been used in our institution for bone tumor resection and when applicable allograft reconstruction. This paper reports the mid- to long-term medical outcomes on a large series.

Therapy and regeneration-combined bone cements for minimally invasive treatment of neoplastic bone defects

2021 ◽  
Author(s):  
Yu Qu ◽  
Hui Zhuang ◽  
Meng Zhang ◽  
Yufeng Wang ◽  
Dong Zhai ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Minimally Invasive ◽  
Tumor Cells ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Bone Defects ◽  
Bone Cements ◽  
Invasive Treatment ◽  
Calcium Phosphate Cements ◽  
Bone Tumor Resection

Although calcium phosphate cements (CPC) have been clinically used to repair bone defects caused by bone tumor resection, traditional CPC cannot kill the remaining tumor cells after surgery and prevent...

scholarly journals Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Ahmed Hamed Kassem Abdelaal ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
Shinji Miwa ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Limb Salvage ◽  
Bone Tumor ◽  
Treatment Options ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Leg Length ◽  
Primary Bone Tumors ◽  
Bone Tumor Resection ◽  
Bone Autograft

Limb salvage surgery has become the standard treatment for malignant primary bone tumors in the extremities. Limb salvage represents a challenge in skeletally immature patients. Several treatment options are available for limb reconstruction after tumor resection in children. We report our results using the technique of epiphyseal sparing and reconstruction with frozen autograft bone in 18 children. The mean follow-up period for the all patients included in this study is 72 ± 26 m. Eight patients remained disease-free, seven patients lived with no evidence of disease, two were alive but with disease, and one patient died of the disease. Five- and ten-year rates of survival were 94.4%. Graft survival at 5 and 10 years was 94.4%. Functional outcome using the Enneking scale was excellent in 17 patients (94.4%) and poor in one patient (5.5%). Complications include 2 nonunions, 2 fractures, 2 deep infections, 1 soft tissue recurrence, and leg length discrepancy in 7 cases. This technique is a good reconstructive choice in a child with a nonosteolytic primary or secondary bone tumor, responsive to chemotherapy, without involvement of the articular cartilage. It is a straight forward, effective, and biological technique, which affords immediate mobilization of joints and possible cryoimmune effects, with excellent long term functional outcome and less complication.

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