Log in

Techniques in surgical navigation of extremity tumors: state of the art

  • Orthopedic Oncology: New Concepts and Techniques (JH Schwab, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

    Article  Google Scholar 

  2. Wong KC, Kumta SM. Use of computer navigation in orthopedic oncology. Curr Surg Rep. 2014;2:47.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Satcher Jr RL. How intraoperative navigation is changing musculoskeletal tumor surgery. Orthop Clin N Am. 2013;44(4):645–56.

    Article  Google Scholar 

  4. Cheong D, Letson GD. Computer-assisted navigation and musculoskeletal sarcoma surgery. Cancer Control. 2011;18(3):171–6.

    PubMed  Google Scholar 

  5. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  6. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Wong KC, Kumta SM. Computer-assisted tumor surgery in malignant bone tumors. Clin Orthop Relat Res. 2013;471(3):750–61.

    Article  PubMed Central  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  13. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

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

Authors

Corresponding author

Correspondence to Luis A. Aponte-Tinao.

Additional information

This article is part of the Topical Collection on Orthopedic Oncology: New Concepts and Techniques

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-015-9305-8

Keywords

Navigation