Computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee: outcomes of 12 cases

Abstract

BackgroundTo report the outcomes of computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee.MethodsComputed tomography (CT) and magnetic resonance imaging (MRI) data were input into computer software to produce three-dimensional (3D) models of the tumor extent. Imaging data was then used to create a template for surgical resection, and development of an individualized combined allogeneic bone/endoprosthesis. Surgical simulations were performed prior to the actual surgery.ResultsThis study included 9 males and 3 females with a mean age of 25.3 years (range, 13 to 40 years). There were 9 tumors in the distal femur and 3 in the proximal tibia. There were no surgical complications. In all cases pathologically confirmed clear surgical margins were obtained. Postoperative radiographs showed the range of tumor resection was in accordance with the preoperative design, and the morphological reconstruction of the bone defect was satisfactory with complete bilateral symmetry. The mean follow-up time was 26.5 months. Two patients died of their disease and the remaining are alive and well without evidence of recurrence. All patients are able to ambulate freely without restrictions. At the last follow-up, the average International Society of Limb Salvage score was 25.8 (range, 18 to 27), and was excellent in 8 cases and good in 4 cases.ConclusionsComputer-aided design and modeling for the surgical management of bone tumors and subsequent limb reconstruction provides accurate tumor removal with the salvage of a maximal amount of unaffected bone and precise endoprosthesis reconstruction.

Orthopaedic tumors: What problems are we solving, and are universities and major medical centers doing enough?

“…39 The accuracy of the procedure may be measured by matching the preoperative virtual planning with the 3-D virtual surgical specimen obtained after tumor resection. Ding et al 40 explained the outcomes of the use of computer-aided design for the resection of tumors around the knee. This technique allows the surgeons to remove precisely the tumor from a pre-operative3-D map.…”

3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee

“…The results of the parameters for the follow-up are detailed in Table 2 . Specifically, the mean operation time was 272 min (slightly shorter than the reported 5 hours) 15 ; the mean volume of blood loss was 388 mL; the mean MSTS score was 27.13 according to their last follow-up; and the mean value of maximum flexion of affected knees was 114.08° (105° to 128°). The results of knee ROMs in 6DOF during the gait are presented in Table 3 , which is comparable with the normative data of Chinese gaits 21 .…”

“…Hence, optimizing the plate system used for fixing the bone after microwave ablation is necessary to improve the effectiveness of bone reconstruction. Recently, toward this goal, the utility and encouraging clinical outcomes of computer-aided design (CAD)/computer-aided manufacture (CAM) techniques in the orthopedic fields have been reported 15 – 18 . For example, Xu et al .…”

Imaging of the Knee and Surrounding Structures Following Tumor Surgery

“…Computer-aided design and three-dimensional models may also be used to help plan the surgical technique and any custom-made jigs. 68 Following an EPR, bone ingrowth may be seen into any collar around the implant. There may be a thin rim of lucency at this interface, constituting normal movement.…”