Computer assisted surgery in orthopaedic oncology:Indications, applications and surgical workflow

In the treatment of bone tumors surgical accuracy and precision are of vital importance to achieve an efficient but oncologically safe result. Most procedures in bone tumour surgery require intraop-erative imaging (fluoroscopy) and/or measurements for anatomical orientation and margin control. Computer-assisted surgery (CAS), a GPS-like system in the OR, is a recently developed alternative. CAS was at least clinically equivalent to fluoroscopy use in curettage type treatment while not relying on ionizing radiation use. Arguably it is better in difficult anatomical locations. While there is additional intra-operative set-up time, CAS curettage takes equally as long.CAS can be used for both simple and complex resection procedures that include some joint saving procedures that would be impossible otherwise. Analysis showed a high number of safe resections, higher than comparative non-CAS studies. CAS allograft shaping (defect reconstruction) showed high accuracy in experimental and clinical studies. This can potentially reduce complications as fractures and shorten rehabiliation times. Better tools can further increase graft creation accuracy as has been demonstrated in the experimental study. Imageless resection and tumor prosthesis placement was helpful in length, joint line and rotation reconstruction.Computer-assisted surgery systems are a relatively new development in orthopaedic oncology. It can be used to reconstruct large defects with a high degree of accuracy using grafts and/or (custom) prosthesis, enabling more joint salvage surgery and/or increase in patient function. Complete integration of spatial (tool) awareness, advanced imaging possibilities and per-patient reconstructions can potentially completely change the oncological surgical workflow