Intraoperative Navigation, 3D Printed Prostheses, and Conventional Techniques in Femoral and Tibial Tumor Resections: A Systematic Review.

Abstract

Technological advancements in orthopaedic oncology continue to augment our approach to surgical interventions. However, the impact on patient outcomes following lower extremity bone tumor resections remains under-characterized. This systematic review identifies the impact of various technological advancements on post-operative outcomes. A systematic search of PubMed, Embase, and Cochrane Library databases (2014-2024) identified studies on lower extremity bone tumor resections involving 3D prostheses/patient-specific instruments (3D PSI), intraoperative navigation, and control conventional surgeries. Individual case reports, cadaveric, and animal studies were excluded. Two reviewers independently screened abstracts and extracted Musculoskeletal Tumor Society (MSTS) scores and data on complications (infections, fractures, revisions). Interventions were segmented by use of technology in surgery between 3D patient-specific instrumentation (PSI), intraoperative navigation and conventional approaches. Descriptive analysis was employed to calculate the weighted means, frequencies, and proportions of complications across technology subgroups. Out of 2841 studies screened, 40 studies with 606 patients met inclusion criteria. Average patient age was 30.7 ± 14.3 years with mean follow-up period of 32.9 ± 20.5 months. Overall complication rates were 11.9 ± 12.9 for 3D PSI, 16.4 ± 16.7% for intraoperative navigation, and 32.7 ± 2.8% for conventional. Weighted mean infection rates were 3.3 ± 6.2% for 3D PSI, 3.4 ± 4.3% for intraoperative navigation, and 7.2 ± 7.8% for conventional. Mean revision rates were 1.6 ± 5.4% for 3D PSI, 2.5 ± 5.6% for intraoperative navigation, and 7.2 ± 3.1% for conventional. Weighted mean MSTS scores were similar between groups (26.4 ± 4.4 3D PSI, 25.4 ± 2.8 intraoperative navigation, 26.2 ± 6.2 conventional). This Level III Evidence study's results suggest that application of technological advances to operative management of musculoskeletal tumors may decrease complication rates while maintaining MSTS scores.