Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

Abstract

Background and Objectives: The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. Methods: Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. Results: Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. Conclusions: Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience

“…Both in vitro and in vivo studies have shown that the use of PSI confers superior cut precision over freehand osteotomy and comparable precision to navigation techniques 4,28,29 . Moreover, cadaveric studies have demonstrated improved efficiency with the use of PSI over both freehand and navigation techniques, 30 aligning with our previous work using a sawbones model which found that the improved precision afforded by 3D‐printed PSI technology led to less damage to simulated pelvic viscera 31 …”

“…4,28,29 Moreover, cadaveric studies have demonstrated improved efficiency with the use of PSI over both freehand and navigation techniques, 30 aligning with our previous work using a sawbones model which found that the improved precision afforded by 3D-printed PSI technology led to less damage to simulated pelvic viscera. 31 In recent years, our institution has made a gradual transition away from freehand resection for internal hemipelvectomy in favor of computer navigation and novel 3D-printed PSI designs (Figure 3).…”

Digital chain for pelvic tumor resection with 3D-printed surgical cutting guides

“…Nevertheless, the main body alone was not enough to correctly position the SCG. Therefore, added positioning features were added that were similar to what Siegel et al (2020 ), Evrard et al (2019 ), and Cernat et al (2016 ) recommended. These positioning features were added preferably in accessible areas of the bone to limit additional dissection, and their width can be limited to a maximum defined by the surgeon.…”

“…It produced accurate printing of the SCGs. It is also the most popular choice in pelvic resection guides in the literature ( Cartiaux et al, 2014 ; Gouin et al, 2014 ; Wong et al, 2015 ; Jentzsch et al, 2016 ; Sallent et al, 2017 ; Evrard et al, 2019 ; Siegel et al, 2020 ). PA12 was the material selected for this study.…”

“…However, there does not seem to be any set methodology for designing such guides ( Numajiri et al, 2018 ). Recent publications, using pelvic surgical guides, showed a wide variety of designs with no clearly classified or standardized features ( Wang et al, 2017 ; Evrard et al, 2019 ; Siegel et al, 2020 ; Gkagkalis et al, 2021 ) . The only feature that is common to any surgical guide is the positioning, which uses the negative shape of the bone.…”