Vol 1 | Issue 2 | Sep\u00a0– Dec 2015 | page:17-21 | James E. Archer[1], Philippa L. May [2], Lee M. Jeys[1,2*]<\/p>\n
[1]The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
\n[2]College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
\n[3]Professor of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK<\/p>\n
Address of Correspondence<\/strong> Surgical navigation has been used by neurosurgery for a number of years as a method for accurately locating and resecting tumours within the brain. The anatomy of bony structures does not alter between image acquisition and the surgical procedure, therefore computer assisted technology lends itself well to use in orthopaedic surgery. Studies have demonstrated that this technology improves orthopaedic surgical accuracy across a wide breadth of procedures such as arthroplasty, knee ligament reconstructions and more recently, bone tumour surgery. This article aims to identify the importance of this new technology in paediatric bone tumour surgery and give an overview on its use. Introduction<\/span><\/strong><\/p>\n Paediatric orthopaedic tumour surgery is one of the most challenging areas of orthopaedic oncology. Tumours can be found in a number of regions, with the pelvis being one of the most challenging. The removal of a tumour, post-operative complications and need for revision, all have a large impact on quality of life in paediatric patients. The complexity of the pelvic region and the associated nerve and organ structures mean that surgical excision of tumours must be very precise. Resection without Computer Asissted Orthopaedic Surgery (CAOS) has a high rate of local recurrence because of the difficulty of achieving a wide local excision [1]. The use of computer assisted technology in sarcoma surgery has improved surgical outcomes by reducing local recurrence, reducing revision rates and by decreasing the rate of amputations and nerve root damage [2,3].<\/p>\n The tumour types<\/span><\/strong> <\/a> <\/a>
\nProfessor Lee M. Jeys, MBChB, MSc (Ortho. Engin.), FRCS (Tr. & Orth.), Professor of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
\ne-mail: lee.jeys@nhs.net<\/p>\n
\nAbstract<\/span><\/h3>\n
\nKey Words:<\/strong><\/span> Computer assisted orthopaedic surgery, Paediatric, Oncology.<\/p>\n
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\nTwo tumour types are often seen in the pelvis in the paediatric population. Osteosarcomas are the most common primary bone tumour and they are most commonly seen in teenagers and young adults. They form approximately 20% of all primary bone tumours and approximately 8% of these will be found in the pelvis [4].<\/p>\n
\nEwing’s sarcoma is a rarer tumour, with around 65-75 cases per year in the UK. It is far more common in the paediatric population with a median age at diagnosis of 15 [5]. Pelvic Ewing’s sarcoma is seen in 26% of all patients [6].
\nIn the UK, pelvic Ewing’s sarcoma are often treated pre-operatively with chemotherapy plus either radiotherapy or proton therapy. This makes surgery in the pelvis even more challenging and also has led to an increasing trend not to perform reconstruction due to the high risk of complications. This therefore makes protecting nerve roots and the hip joint essential to maintaining function.<\/p>\n
\nWhile these tumours in the pelvis are rare and do not represent a large case load, they are often significantly advanced at the time of presentation. This is in part due to their rarity, but also due to the fact that localised symptoms only become apparent late in the condition as the pelvis can contain a large tumour without displaying symptoms. Also because of the young age of the patients, the impact on quality of life and functionality can be significant. This is especially true when considering the extent of surgical intervention that children often require. The length and complexity of surgery also means complications such as infection, dislocation and recurrence are high.
\nCAOS has been used less frequently in the lower limbs at our centre but has been used at other units extensively [7]. One case of the use of CAOS in the lower limb is presented in this article. Other applications for CAOS include its use in biopsy and for radio-frequency ablation [8].<\/p>\n