J Korean Orthop Assoc.  2013 Dec;48(6):419-425. 10.4055/jkoa.2013.48.6.419.

Navigation-Assisted Orthopedic Surgery in Bone Tumor

• Cho HS
• Yang SH
• Park HB
• Han I
• Kim HS

• KMID: 2185275
• DOI: http://doi.org/10.4055/jkoa.2013.48.6.419

Abstract

The usefulness and accuracy of computer-assisted surgery have been evaluated clinically in many orthopedic fields, including joint replacement arthroplasty, pedicle screw placement, and cruciate ligament reconstruction of the knee joint. Since several preliminary reports on application of navigation to bone tumor resection and reconstruction surgery have recently been issued, navigation-assisted surgery for bone tumors has received significant attention with regard to its usefulness. In particular, navigation can be helpful during surgery for musculoskeletal tumors, because it can maximize the accuracy of resection and minimize the unnecessary sacrifice of normal tissue by providing precise intraoperative three-dimensional radiological information. In addition, it is helpful in prosthetic reconstruction, because preoperative virtual simulation makes it possible to estimate size and location of bone defect to be left after tumor resection. Surgeons should recognize that use of navigation systems in bone tumor surgery has some hidden pitfalls. Here, based on our clinical results, we describe the surgical techniques that we have used and include some cautionary notes.

Keyword

bone tumor; navigation

MeSH Terms

Arthroplasty, Replacement
Joints
Knee Joint
Ligaments
Orthopedics*
Surgery, Computer-Assisted

Figure

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  Figure 1 An 18-year-old girl with an osteosarcoma of the right distal femur (A) underwent joint-preserving limb salvage surgery under navigation guidance (B, C). (D) At postoperative five years, she had no evidence of disease and no functional impairment of the knee.

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  Figure 2 The registration error is not the same as the navigation error. When fiducials are concentrically located around the tumor, navigation errors at the area of concern are largely due to registration errors. However, if fiducials are eccentrically located, navigation error is greater than the registration error. Theoretically, at least four wires are necessary for concentric location of fiducials in all planes. Reproduced from the article of Cho et al. (J Korean Bone Joint Tumor Soc 2009;15:1-5) with permission of the copyright holder.

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  Figure 3 An osteotomy of the pelvic ring may disrupt the previously set spatial relationship between the registration points and the reference frame. DRB: dynamic reference-base.

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