Computer-Navigated Bone Cutting in the Resection of a Pelvic Bone Tumor and Reconstruction with a Massive Bone Allograft.

INTRODUCTION

We present here a surgical technique using a navigation system and an oscillating saw for the resection of a pelvic bone tumor combined with an allograft reconstruction.

STEP 1 PREOPERATIVE PLANNING: The surgeon and radiologist together delineate the tumor on each magnetic resonance imaging (MRI) slice; then the surgeon defines target planes for tumor resection and transfers them to the allograft.

STEP 2 PATIENT POSITIONING AND SURGICAL EXPOSURE: With the patient in the lateral decubitus position, combine ilioinguinal with iliocrural and obturator surgical approaches to expose the ilium.

STEP 3 NAVIGATED TUMOR RESECTION: Perform the osteotomies using the navigation system to guide the saw blade, following predefined target planes; perform a biopsy.

STEP 4 NAVIGATED ALLOGRAFT CUTTING: Perform the osteotomies using the navigating saw, following the same target planes as used for the tumor resection.

STEP 5 PELVIC RECONSTRUCTION: Fix the graft and cement a femoral stem in place; then reinsert all detached tendons and elevated muscles.

RESULTS & PREOP/POSTOP IMAGES: This technique is based on preliminary work that has not been presented in a peer-reviewed case series publication.

WHAT TO WATCH FOR

IndicationsContraindicationsPitfalls & Challenges.