Improving the accuracy of wide resection of bone tumors and enhancing implant fit: A cadaveric study

Helguero, Carlos G.; Kao, Imin; Komatsu, David E.; Shaikh, Shazad; Hansen, David V.; Franco, Jacob; Khan, Farhat Ullah

doi:10.1016/j.jor.2015.10.010

Cited by 21 publications

(20 citation statements)

References 10 publications

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“…When the 5 mm acceptability criterion was applied ( 18 Other cadaver studies demonstrated that custom-made jigs improved accuracy in multiple resection planes 16 and provided less cut deviation. 17 Outcomes contrasting computerized navigation and patientspecific guided procedures to the freehand technique have been reported in other orthopaedic subspecialties 23,24 ; however, we believe that our study is the first to compare all three for SI joint tumor resections.…”

Section: Resultsmentioning

confidence: 99%

“…7 Basic science and clinical studies have shown better adherence to predetermined margins as well as other results with the aid of PSI devices. 11,[14][15][16][17][18] The lack of any gold standard cutting method encouraged us to investigate: (1) Does freehand, computerized navigation, or the patientspecific cutting guide technique achieve the most accurate planned cut in a Sawbones model? (2) Which technique causes the least far-side damage to pelvic viscera and important neurovascular structures beyond the resection margins?…”

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confidence: 99%

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Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Siegel

Balach

Sweeney

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. Methods: Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. Results: Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. Conclusions: Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Siegel

Balach

Sweeney

et al. 2020

Journal of Surgical Oncology

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“…Accuracy assessments of CT-based 3D models showed positive results for CMF surgery, 11,15 corrective osteotomies of malunions 18,25,37 and bone tumour resections. 28,38 For total knee arthroplasty, the added value of guides and the expected improvement in accuracy have been questioned. 29,39,40 Most studies report on accuracy of implant positioning or leg alignment on two-dimensional (2D) X-rays as commonly used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Accuracy assessment of surgical planning and three-dimensional-printed patient-specific guides for orthopaedic osteotomies

Sys

Eykens

Lenaerts

et al. 2017

Proc Inst Mech Eng H

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This study analyses the accuracy of three-dimensional pre-operative planning and patient-specific guides for orthopaedic osteotomies. To this end, patient-specific guides were compared to the classical freehand method in an experimental setup with saw bones in two phases. In the first phase, the effect of guide design and oscillating versus reciprocating saws was analysed. The difference between target and performed cuts was quantified by the average distance deviation and average angular deviations in the sagittal and coronal planes for the different osteotomies. The results indicated that for one model osteotomy, the use of guides resulted in a more accurate cut when compared to the freehand technique. Reciprocating saws and slot guides improved accuracy in all planes, while oscillating saws and open guides lead to larger deviations from the planned cut. In the second phase, the accuracy of transfer of the planning to the surgical field with slot guides and a reciprocating saw was assessed and compared to the classical planning and freehand cutting method. The pre-operative plan was transferred with high accuracy. Three-dimensional-printed patient-specific guides improve the accuracy of osteotomies and bony resections in an experimental setup compared to conventional freehand methods. The improved accuracy is related to (1) a detailed and qualitative pre-operative plan and (2) an accurate transfer of the planning to the operation room with patient-specific guides by an accurate guidance of the surgical tools to perform the desired cuts.

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“…The subjective measure of the fit, however, was not excellent for all cases. In human implant surgery, the use of customized cutting guides improves the fit accuracy compared with freehand osteotomies . The design of the cutting guide used in this study evolved to improve its accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…In human implant surgery, the use of customized cutting guides improves the fit accuracy compared with freehand osteotomies. 31,32 The design of the cutting guide used in this study evolved to improve its accuracy. The most important factor identified F I G U R E 9 Radiograph showing the long oblique fracture in the radius for the imperfect fit of the endoprosthesis with the host bones was loss of anatomic alignment after removal of the distal aspect of both radius and ulna.…”

Section: Complicationsmentioning

confidence: 99%

Limb‐sparing in dogs using patient‐specific, three‐dimensional‐printed endoprosthesis for distal radial osteosarcoma: A pilot study

Séguin¹,

Pinard²,

Lussier

et al. 2019

Vet Comparative Oncology

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Limb‐sparing for distal radial osteosarcoma has a high rate of complications. Using personalized three‐dimensional (3D)‐printed implants might improve outcome. The goals of this study were to optimize use of patient‐specific, 3D‐printed endoprostheses for limb‐sparing in dogs in the clinical environment and to report the outcome. This was a pilot study where five client‐owned dogs were enrolled. Computed tomography (CT) of the thoracic limbs was performed, which was used to create patient‐specific endoprostheses and cutting guides, and repeated on the day of surgery. Intra‐arterial (IA) carboplatin was introduced in the clinical management. Limb‐sparing was performed. Outcome measures were time required to produce the endoprosthesis and cutting guide, fit between cutting guide and endoprosthesis with host bones, gait analysis, size of the tumour, percent tumour necrosis, complications, disease‐free interval (DFI) and survival time (ST). Four dogs received IA carboplatin. Excessive tumour growth between planning CT and surgery did not occur in any dog. The interval between the CT and surgery ranged from 14 to 70 days. Fit between the cutting‐guide and endoprosthesis with the host bones was good to excellent. At least one complication occurred in all dogs. Two dogs were euthanized with STs of 192 and 531 days. The other dogs were alive with a follow up of 534 to 575 days. IA chemotherapy is a promising strategy to minimize the risk of excessive tumour growth while waiting for the endoprosthesis and cutting‐guide to be made. The design of the cutting‐guide was critical for best fit of the endoprosthesis with host bones.

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Improving the accuracy of wide resection of bone tumors and enhancing implant fit: A cadaveric study

Abstract: In summary, customized 3-D jigs were shown to improve the accuracy-of-fit between implants and host bone, moving this technology closer to clinical implementation.

Cited by 21 publications

References 10 publications

Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Accuracy assessment of surgical planning and three-dimensional-printed patient-specific guides for orthopaedic osteotomies

Limb‐sparing in dogs using patient‐specific, three‐dimensional‐printed endoprosthesis for distal radial osteosarcoma: A pilot study

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