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.
Highlights
To report the outcomes of computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee
Osteosarcoma is the most common primary bone tumor, and approximately 70% of osteosarcomas occur around the knee joint [1,2]
Technological advances have led to the use of computerassisted surgery and computer-aided design (CAD) in many medical fields including oncology and orthopedics [9,10,11,12,13,14,15,16,17,18,19]
Summary
To report the outcomes of computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee. Though in the past bone sarcomas were primarily treated with amputation, advances in surgical techniques and chemotherapy have greatly improved the prognosis, and currently long-term disease free survival rates for patients with osteosarcomas with no metastases at presentation range from 60 to 80% [3]. We have uniquely used preoperative CAD to plan the surgical resection and develop a custom endoprosthesis for patients with malignant bone tumors. The purpose of this study is to describe the technique and to report the results in 12 patients with malignant bone tumors of the distal femur or proximal tibia
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