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: Editor's note: 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.