Improved Accuracy with 3D Planning and Patient-Specific Instruments During Simulated Pelvic Bone Tumor Surgery

Abstract

In orthopaedic surgery, resection of pelvic bone tumors can be inaccurate due to complex geometry, limited visibility and restricted working space of the pelvis. The present study investigated accuracy of patient-specific instrumentation (PSI) for bone-cutting during simulated tumor surgery within the pelvis. A synthetic pelvic bone model was imaged using a CT-scanner. The set of images was reconstructed in 3D and resection of a simulated periacetabular tumor was defined with four target planes (ischium, pubis, anterior ilium, and posterior ilium) with a 10-mm desired safe margin. Patient-specific instruments for bone-cutting were designed and manufactured using rapid-prototyping technology. Twenty-four surgeons (10 senior and 14 junior) were asked to perform tumor resection. After cutting, ISO1101 location and flatness parameters, achieved surgical margins and the time were measured. With PSI, the location accuracy of the cut planes with respect to the target planes averaged 1 and 1.2 mm in the anterior and posterior ilium, 2 mm in the pubis and 3.7 mm in the ischium (p < 0.0001). Results in terms of the location of the cut planes and the achieved surgical margins did not reveal any significant difference between senior and junior surgeons (p = 0.2214 and 0.8449, respectively). The maximum differences between the achieved margins and the 10-mm desired safe margin were found in the pubis (3.1 and 5.1 mm for senior and junior surgeons respectively). Of the 24 simulated resection, there was no intralesional tumor cutting. This study demonstrates that using PSI technology during simulated bone cuts of the pelvis can provide good cutting accuracy. Compared to a previous report on computer assistance for pelvic bone cutting, PSI technology clearly demonstrates an equivalent value-added for bone cutting accuracy than navigation technology. When in vivo validated, PSI technology may improve pelvic bone tumor surgery by providing clinically acceptable margins.

One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection

“…It concurred with the results in a simulated sawbone study that the 3D planning and PSI could improve the accuracy of pelvic bone tumor surgery. [14] Our finding suggested that the tumor PSI might even support a more difficult multiplanar osteotomy in the pelvic region with complex anatomy. This enabled surgeons to resect bone tumors with just adequate margin but yet it could maximally preserve the surrounding normal bone for reconstruction with a better function.…”

“…In contrast to computer navigation assisted surgery, the tumor PSI could achieve an acceptable resection accuracy by a shorter time and did not involve bulky instruments and other supporting facilities. [14,15] Also, the favorable final Figure 5. (A) The design of PSI had the cutting platforms or slits that matched the planned resection planes; the flanges with the contoured shape that allowed a unique PSI positioning on the surgical accessible bone surface decided by the surgeons at the CAD software; and the K-wire holes on the flanges for stabilizing the PSI to the bone.…”

“…It could provide good bone cutting accuracy and might improve pelvic tumor surgery by achieving clinically acceptable margins. [14] PSI has been described in a case report that it could facilitate the resection of extremity bone tumor and reconstruction with a custom prosthesis, similar to that achieved by navigational assistance. [15] As pelvic bone has complex three dimensional (3D) geometry, 3D printing technology with Additive Layer Manufacturing (ALM) techniques will be ideal for fabricating an anatomical conforming custom implant with internal lattice structures that enhance osseointegration at the bone-implant junctions.…”

Development and Initial Porcine and Cadaver Experience with Three-Dimensional Printing of Endoscopic and Laparoscopic Equipment

“…[12][13][14][15][16]18 These studies document the unique ability 3D printing technology has to improve complex reconstructive procedures. In contrast, we directed our efforts toward the design and production of frequently utilized disposable medical equipment.…”

Web-based Collaborative Platform for Personalized Orthopaedic Applications

“…Personalized medicine means "providing the right treatment to the right patient at the right time" [4], one perspective of this approach being focused on designing, manufacturing and using customized instruments (such as surgical guides [3]) or implants [2] based on patient anatomical data.…”