title: Image navigation assisted joint-saving surgery for treatment of bone sarcoma around knee in skeletally immature patients.
abstract: OBJECTIVE
  It is challenge to perform a native joint preserving resection for skeletally immature patients with bone sarcomas around the knee. We determined whether tumor resection under image-guided navigation make joint-saving surgery possible for juxta-articular sarcomas around knee while adhering oncological principles.
  
  
  METHODS
  We performed joint-saving limb salvage surgeries on eight patients with metaphyseal bone sarcomas (6 in proximal tibia, 2 in distal femur). Six tumors extend to and 2 beyond the epiphyseal line. Planned tumor resection under image-guided navigation was employed for obtaining clear surgical margin while maximizing host tissue preservation. All tumors were en bloc removed and intercalary defect were reconstructed by combination of allograft with vascularized fibula flap. All specimens were examined for resection margin. Patients were followed up at average of 40.5 months for evaluating of oncologic and functional outcomes.
  
  
  RESULTS
  Entire joints were preserved in 5 patients and partial joints were saved in 3 patients. Clear surgical margins were achieved in all patients. The minimum of surgical margin width in bone is 6 mm in this series. No patient experienced local recurrence. Bone union achieved in all cases during the study period. The average MSTS score was 27.1 at final follow-up.
  
  
  CONCLUSIONS
  With careful patient selection, image navigation aided bone tumor resection was proved to be an effective way in joint-saving limb salvage procedures for treating skeletally immature patients with juxta-articular bone sarcomas around the knee.
authors: Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an 710032, People's Republic of China. Electronic address: ljfmmu@sina.com.
authors: Jing
authors: J
authors: Li
authors: Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an 710032, People's Republic of China. Electronic address: shilei_med@163.com.
authors: Lei
authors: L
authors: Shi
authors: Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an 710032, People's Republic of China. Electronic address: guojing_chen@126.com.
authors: Guo-jing
authors: GJ
authors: Chen
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007719:Knee Joint / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D018365:Neoplasm, Residual; D012516:Osteosarcoma / Q000601:surgery*; D018579:Patient Selection; D012512:Sarcoma, Ewing / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Bone sarcoma; Joint-saving surgery; Knee; Limb salvage; Navigation