Three-dimensional digital technology-assisted precise tumor resection and reconstruction of the femoral trochanter and postoperative functional recovery: a retrospective study

Abstract

Background

The trochanter of the femur is a common site for bone tumors. However, locating the specific boundary of bone tumor infiltration and determining the surgical method can be challenging. The objective of this study was to review the diagnosis, treatment, and surgical outcomes of patients with tumors or tumor-like changes in the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction of the trochanter.

Methods

From January 2005 to September 2020, 11 patients with trochanteric tumors (aged: 18–53 years; six males and five females) were treated in Guangzhou First People's Hospital. The cases included aneurysmal bone cyst (n = 1), giant cell tumor of bone (n = 2), fibrous histiocytoma of bone (n = 1), endochondroma (n = 1), and fibrous dysplasia of bone (n = 6). For patients with trochanteric tumors, computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion. A three-dimensional digital model of bilateral lower limbs was reconstructed by computer technology, the boundary of tumor growth was determined by computer simulation, the process of tumor resection and reconstruction was simulated, and the personalized guide template was designed. During the operation, the personalized guide plate guided the precise resection of the tumor, and the allogeneic bone was trimmed to match the shape of the bone defect.

Results

All 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction of the hip. In eight cases, the lesion was confined to the trochanter, which was fixed with large segment allogeneic bone, autologous iliac bone, and proximal femoral anatomic plate. In three cases, allogeneic bone, autologous iliac bone, and femoral reconstruction nail were used to fix the tumor under the trochanter. Postoperative X-ray examination showed that the repair and reconstruction of the bone defect was effective, and callus bridging between the allogenic bone and autogenous bone was observed 6 months after operation. All patients recovered their walking function 3–6 months after operation. The duration of the follow-up period ranged from 6 months to 6 years. A patient experienced recurrence of endochondroma; pathological examination revealed chondrocytic sarcoma. The remaining 10 patients were treated with segmental resection and reconstruction. The operation time ranged 2.5–4.5 h (average: 3.2 h). Intraoperative blood loss ranged from 300 to 500 ml (average: 368 ml). The local recurrence rate was 9.1%, and the overall survival rate was 100%. The average Musculoskeletal Tumor Society score was 27 (excellent and good for eight and three patients, respectively).

Conclusions

Three-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique, which might markedly improve the surgical effect, shorten the surgical time, increase the overall survival rate of patients with tumors, reduce the local recurrence rate, assist in the digitization and programming of femoral trochanteric tumor surgery, and improve surgical accuracy.