Abstract
Image-guided surgical navigation allows the orthopedic oncologist to perform adequate tumor resection based on fused images (CT, MRI, PET). Although surgical navigation was first performed in spine and pelvis, recent reports have described the use of this technique in bone tumors located in the extremities. In long bones, this technique has moved from localization or percutaneous resection of benign tumors to complex bone tumor resections and guided reconstructions (allograft or endoprostheses). In recent years, the reported series have increased from small numbers (5 to 16 patients) to larger ones (up to 130 patients). The purpose of this paper is to review recent reports regarding surgical navigation in the extremities, describing the results obtained with different kind of reconstructions when navigation is used and how the previously described problems were solved.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Krettek C, Geerling J, Bastian L, Citak M, Rücker F, Kendoff D, et al. Computer aided tumor resection in the pelvis. Injury. 2004;35 Suppl 1:S-A79–83.
Wong KC, Kumta SM. Use of computer navigation in orthopedic oncology. Curr Surg Rep. 2014;2:47.
Satcher Jr RL. How intraoperative navigation is changing musculoskeletal tumor surgery. Orthop Clin N Am. 2013;44(4):645–56.
Cheong D, Letson GD. Computer-assisted navigation and musculoskeletal sarcoma surgery. Cancer Control. 2011;18(3):171–6.
Saidi K. Potential use of computer navigation in the treatment of primary benign and malignant tumors in children. Curr Rev Musculoskelet Med. 2012;5(2):83–90.
Gerbers JG, Stevens M, Ploegmakers JJ, Bulstra SK, Jutte PC. Computer-assisted surgery in orthopedic oncology. Acta Orthop. 2014;85(6):663–9. This is the larger series (130 cases) in which surgical navigation was utilized.
Wong KC, Kumta SM. Computer-assisted tumor surgery in malignant bone tumors. Clin Orthop Relat Res. 2013;471(3):750–61.
Ritacco LE, Milano FE, Farfalli GL, Ayerza MA, Muscolo DL, Aponte-Tinao LA. Accuracy of 3-D planning and navigation in bone tumor resection. Orthopedics. 2013;36(7):e942–50.
Aponte-Tinao L, Ritacco LE, Ayerza MA, Muscolo DL, Albergo JI, Farfalli GL. Does intraoperative navigation assistance improve bone tumor resection and allograft reconstruction results? Clin Orthop Relat Res. 2015;473(3):796–804. The authors described surgical navigation to resected bone tumors and to select and cut the allograft to fit precisely in 69 patients.
Young PS, Bell SW, Mahendra A. The evolving role of computer-assisted navigation in musculoskeletal oncology. Bone Joint J. 2015;97-B(2):258–64. Preoperative planning time and intraoperative surgical navigation is measured, and decreased after the first five cases.
Kang HG, Cho CN, Kim KG. Percutaneous navigation surgery of osteoid osteoma of the femur neck. Minim Invasive Ther Allied Technol. 2014;23(1):58–62.
Wong KC, Kumta SM. Joint-preserving tumor resection and reconstruction using image-guided computer navigation. Clin Orthop Relat Res. 2013;471(3):762–73. The authors used surgical navigation to resected bone tumors and to designed and developed custom prostheses.
Lall A, Hohn E, Kim MY, Gorlick RG, Abraham JA, Geller DS. Comparison of surface area across the allograft-host junction site using conventional and navigated osteotomy technique. Sarcoma. 2012;2012:197540. This study demonstrate that surgical navigation increased the contact area in osteotomy planes for bone cuts in bone allografts.
Wu Z, Fu J, Wang Z, Li X, Li J, Pei Y, et al. Three-dimensional virtual bone bank system for selecting massive bone allograft in orthopaedic oncology. Int Orthop. 2015;39(6):1151–8.
Fan H, Guo Z, Wang Z, Li J, Li X. Surgical technique: unicondylar osteoallograft prosthesis composite in tumor limb salvage surgery. Clin Orthop Relat Res. 2012;470(12):3577–86.
Li J, Wang Z, Guo Z, Chen GJ, Yang M, Pei GX. Precise resection and biological reconstruction under navigation guidance for young patients with juxta-articular bone sarcoma in lower extremity: preliminary report. J Pediatr Orthop. 2014;34(1):101–8. This series described this technique in a pediatric population.
Li J, Wang Z, Guo Z, Wu Y, Chen G, Pei G. Precise resection and biological reconstruction for patients with bone sarcomas in the proximal humerus. J Reconstr Microsurg. 2012;28(6):419–25.
Avedian RS, Haydon RC, Peabody TD. Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas. Clin Orthop Relat Res. 2010;468(10):2754–64.
Li J, Wang Z, Guo Z, Chen GJ, Yang M, Pei GX. Irregular osteotomy in limb salvage for juxta-articular osteosarcoma under computer-assisted navigation. J Surg Oncol. 2012;106(4):411–6.
Aponte-Tinao LA, Ritacco LE, Ayerza MA, Muscolo DL, Farfalli GL. Multiplanar osteotomies guided by navigation in chondrosarcoma of the knee. Orthopedics. 2013;36(3):e325–30.
Gerbers JG, Ooijen PM, Jutte PC. Computer-assisted surgery for allograft sha** in hemicortical resection: a technical note involving 4 cases. Acta Orthop. 2013;84(2):224–6.
Jeys L, Matharu GS, Nandra RS, Grimer RJ. 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. 2013;95-B(10):1417–24.
Milano FE, Ritacco LE, Farfalli GL, Bahamonde LA, Aponte-Tinao LA, Risk M. Transfer accuracy and precision scoring in planar bone cutting validated with ex vivo data. J Orthop Res. 2015;33(5):699–704. This study analyzed the accuracy and precision of the transfer of a planar osteotomy described in a virtual scenario to the anatomy of the patient during a surgical process.
Compliance with Ethics Guidelines
ᅟ
Conflict of Interest
Dr. Aponte-Tinao has received consultant fees from Stryker Orthopedics. Dr. Ritacco, Dr. Milano, Dr. Ayerza, and Dr. Farfalli have nothing to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Orthopedic Oncology: New Concepts and Techniques
Rights and permissions
About this article
Cite this article
Aponte-Tinao, L.A., Ritacco, L.E., Milano, F.E. et al. Techniques in surgical navigation of extremity tumors: state of the art. Curr Rev Musculoskelet Med 8, 319–323 (2015). https://doi.org/10.1007/s12178-015-9305-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12178-015-9305-8