scholarly journals Patient Specific Instruments Can Achieve a Better Surgical Accuracy Than Navigation Assistance in Joint-Preserving Surgery of the Knee Joint: a Cadaveric Comparative Study

10.29007/qcdp ◽  
2018 ◽  
Author(s):  
Sarah Bosma ◽  
Paul Jutte ◽  
Kwok-Chuen Wong ◽  
Laurent Paul ◽  
Jasper Gerbers
Keyword(s):  
Knee Joint ◽  
Computer Navigation ◽  
Surgical Margin ◽  
Bone Sarcoma ◽  
Cadaver Study ◽  
Patient Specific ◽  
Oncologic Surgery ◽  
Joint Preserving Surgery ◽  
Patient Specific Instruments ◽  
Primary Bone Sarcoma

Orthopaedic oncologic surgery requires resection with a safe margin as inadequate surgical margin leads to unfavorable results with an increased rate of local tumor re- currence [1]. Computer Navigation Assisted Surgery (CAS) and Patient Specific In- strumentation (PSI) have been reported to increase accuracy and predictability of tumor resections [2-6]. The technically demanding joint-preserving surgery that re- tains the native joint with the better function may be benefited from the new tech- niques [7]. CAS has the advantages of real-time intraoperative guidance of the bone resections but requires bulky and costly facilities [5]. PSI is a simple option of repli- cating surgical plan but lacks intraoperative image feedback on the surgery [5,6]. As primary bone sarcoma is uncommon, clinical studies for meaningful comparison of the two techniques may not be feasible. The cadaver study was to investigate the surgical accuracy of CAS and PSI in joint-preserving tumor surgery of knee joint.

scholarly journals A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sarah E. Bosma ◽  
Kwok Chuen Wong ◽  
Laurent Paul ◽  
Jasper G. Gerbers ◽  
Paul C. Jutte
Keyword(s):  
Computer Navigation ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Oncologic Surgery ◽  
Engineering Software ◽  
Patient Specific Instrumentation ◽  
Quality Control Tool ◽  
Patient Specific Instruments ◽  
Intraoperative Quality Control

Orthopedic oncologic surgery requires preservation of a functioning limb at the essence of achieving safe margins. With most bone sarcomas arising from the metaphyseal region, in close proximity to joints, joint-salvage surgery can be challenging. Intraoperative guidance techniques like computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) could assist in achieving higher surgical accuracy. This study investigates the surgical accuracy of freehand, CAS- and PSI-assisted joint-preserving tumor resections and tests whether integration of CAS with PSI (CAS + PSI) can further improve accuracy. CT scans of 16 simulated tumors around the knee in four human cadavers were performed and imported into engineering software (MIMICS) for 3D planning of multiplanar joint-preserving resections. The planned resections were transferred to the navigation system and/or used for PSI design. Location accuracy (LA), entry and exit points of all 56 planes, and resection time were measured by postprocedural CT. Both CAS + PSI- and PSI-assisted techniques could reproduce planned resections with a mean LA of less than 2 mm. There was no statistical difference in LA between CAS + PSI and PSI resections (p=0.92), but both CAS + PSI and PSI showed a significantly higher LA compared to CAS (p=0.042 and p=0.034, respectively). PSI-assisted resections were faster compared to CAS + PSI (p<0.001) and CAS (p<0.001). Adding CAS to PSI did improve the exit points, however not significantly. In conclusion, PSI showed the best overall surgical accuracy and is fastest and easy to use. CAS could be used as an intraoperative quality control tool for PSI, and integration of CAS with PSI is possible but did not improve surgical accuracy. Both CAS and PSI seem complementary in improving surgical accuracy and are not mutually exclusive. Image-based techniques like CAS and PSI are superior over freehand resection. Surgeons should choose the technique most suitable based on the patient and tumor specifics.

scholarly journals Surgical Advances in Osteosarcoma

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 388
Author(s):  
Marcus J. Brookes ◽  
Corey D. Chan ◽  
Bence Baljer ◽  
Sachin Wimalagunaratna ◽  
Timothy P. Crowley ◽  
...  
Keyword(s):  
Fluorescent Dyes ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Survival Rates ◽  
Computer Navigation ◽  
Bone Cancer ◽  
Technical Difficulty ◽  
Implant Design ◽  
Patient Specific ◽  
Patient Specific Instruments

Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

scholarly journals Patient-Specific Instruments Based on Knee Joint Computed Tomography and Full-Length Lower Extremity Radiography in Total Knee Replacement

2018 ◽  
Vol 131 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Hua Tian ◽  
Min-Wei Zhao ◽  
Xiao Geng ◽  
Qi-Yun Zhou ◽  
Yang Li
Keyword(s):  
Computed Tomography ◽  
Knee Joint ◽  
Total Knee Replacement ◽  
Lower Extremity ◽  
Knee Replacement ◽  
Full Length ◽  
Patient Specific ◽  
Patient Specific Instruments ◽  
Total Knee

scholarly journals Pelvic Chondrosarcoma Treated by En Bloc Resection with Patient-Specific Osteotomy Guides and Reimplantation of the Extracorporeally Irradiated Bone as an Osseocartilaginous Structural Orthotopic Autograft: A Report of Two Cases with Description of the Surgical Technique

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Georgios Gkagkalis ◽  
Kevin Moerenhout ◽  
Hannes A. Rüdiger ◽  
Daniel A. Müller ◽  
Igor Letovanec ◽  
...  
Keyword(s):  
Computer Navigation ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Patient Specific ◽  
En Bloc ◽  
Primary Tumors ◽  
Complex Anatomy ◽  
Custom Made ◽  
Patient Specific Instruments ◽  
Modular Prostheses

Primary tumors of the pelvis are considered difficult to treat due to the complex anatomy and the proximity of important neurovascular structures. The surgical armamentarium for the treatment of these tumors has evolved with the help of cutting-edge technology from debilitating hemipelvectomies to solutions such as precise resections guided by patient-specific instruments or computer navigation and reconstruction by modular prostheses, 3D-printed custom-made implants, or orthotopic autograft reimplantation after extracorporeal irradiation. Different combinations of these techniques have been described in the literature with various rates of success. We present two cases of pelvic chondrosarcomas successfully treated by a combination of periacetabular resection with patient-specific osteotomy guides and orthotopic reimplantation of the extracorporeally irradiated autograft resulting in retention of the native hip.

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.

scholarly journals An Innovative and Cost-Advantage CAD Solution for Cubitus Varus Surgical Planning in Children

2021 ◽  
Vol 11 (9) ◽  
pp. 4057
Author(s):  
Leonardo Frizziero ◽  
Gian Maria Santi ◽  
Christian Leon-Cardenas ◽  
Giampiero Donnici ◽  
Alfredo Liverani ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Low Cost ◽  
Cost Effective ◽  
Varus Deformity ◽  
Patient Specific ◽  
Cubitus Varus ◽  
Surgical Guide ◽  
Traditional Procedure ◽  
Custom Made ◽  
Patient Specific Instruments

The study of CAD (computer aided design) modeling, design and manufacturing techniques has undergone a rapid growth over the past decades. In medicine, this development mainly concerned the dental and maxillofacial sectors. Significant progress has also been made in orthopedics with pre-operative CAD simulations, printing of bone models and production of patient-specific instruments. However, the traditional procedure that formulates the surgical plan based exclusively on two-dimensional images and interventions performed without the aid of specific instruments for the patient and is currently the most used surgical technique. The production of custom-made tools for the patient, in fact, is often expensive and its use is limited to a few hospitals. The purpose of this study is to show an innovative and cost-effective procedure aimed at prototyping a custom-made surgical guide for address the cubitus varus deformity on a pediatric patient. The cutting guides were obtained through an additive manufacturing process that starts from the 3D digital model of the patient’s bone and allows to design specific models using Creo Parametric. The result is a tool that adheres perfectly to the patient’s bone and guides the surgeon during the osteotomy procedure. The low cost of the methodology described makes it worth noticing by any health institution.

Patient-specific instruments for total knee arthroplasty can accurately predict the component size as used peroperative

2016 ◽  
Vol 25 (12) ◽  
pp. 3844-3848 ◽  
Author(s):  
Martijn G. M. Schotanus ◽  
Daphne A. L. Schoenmakers ◽  
Rob Sollie ◽  
Nanne P. Kort
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Component Size ◽  
Patient Specific Instruments ◽  
Total Knee

Longer duration of symptoms at the time of presentation is not associated with worse survival in primary bone sarcoma

2018 ◽  
Vol 100-B (5) ◽  
pp. 652-661 ◽  
Author(s):  
J. M. Lawrenz ◽  
J. F. Styron ◽  
M. Parry ◽  
R. J. Grimer ◽  
N. W. Mesko
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Bone Sarcoma ◽  
Axial Skeleton ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
Duration Of Symptoms ◽  
Negative Effect ◽  
Primary Bone Sarcoma ◽  
Primary Bone

Aims The primary aim of this study was to determine the effect of the duration of symptoms (DOS) prior to diagnosis on the overall survival in patients with a primary bone sarcoma. Patients and Methods In a retrospective analysis of a sarcoma database at a single institution between 1990 and 2014, we identified 1446 patients with non-metastatic and 346 with metastatic bone sarcoma. Low-grade types of tumour were excluded. Our data included the demographics of the patients, the characteristics of the tumour, and the survival outcome of patients. Cox proportional hazards analysis and Kaplan–Meier survival analysis were performed, and the survivorship of the non-metastatic and metastatic cohorts were compared. Results In the non-metastatic cohort, a longer DOS was associated with a slightly more favourable survival (hazard ratio (HR) 0.996, 95% confidence interval (CI) 0.994 to 0.998, p < 0.001). In all types of tumour, there was no difference in survival between patients with a DOS of greater than four months and those with a DOS of less than four months (p = 0.566). There was no correlation between the year of diagnosis and survival (p = 0.741). A diagnosis of chondrosarcoma (HR 0.636, 95% CI 0.474 to 0.854, p = 0.003) had the strongest positive effect on survival, while location in the axial skeleton (HR 1.76, 95% CI 1.36 to 2.29, p < 0.001) had the strongest negative effect on survival. Larger size of tumour (HR 1.05, 95% CI 1.03 to 1.06, p < 0.001) and increased age of the patient (HR 1.02, 95% CI 1.01 to 1.03, p < 0.001) had a slightly negative effect on survival. Metastatic and non-metastatic cohorts had similar median DOS (16 weeks, p = 0.277), although the median survival (15.5 months vs 41 months) and rates of survival at one year (69% vs 89%) and five years (20% vs 59%) were significantly shorter in the metastatic cohort. Conclusion A longer DOS prior to diagnosis is not associated with a poorer overall survival in patients with a primary bone sarcoma. Location in the axial skeleton remains the strongest predictor of a worse prognosis. This may be helpful in counselling patients referred for evaluation on a delayed basis. Cite this article: Bone Joint J 2018;100-B:652–61.

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