Image-guided installation of 3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery

Nowadays, the diagnosis and treatment of pelvic sarcoma pose a major surgical challenge for reconstruction in orthopedics. With the development of manufacturing technology, the metal 3D-printed customized implants have brought revolution for the limb-salvage resection and reconstruction surgery. However, the tumor resection is not without risk and the precise implant placement is very difficult due to the anatomic intricacies of the pelvis. In this study, a surgical navigation system including the implant calibration algorithm has been developed, so that the surgical instruments and the 3D-printed customized implant can be tracked and rendered on the computer screen in real time, minimizing the risks and improving the precision of the surgery. Both the phantom experiment and the pilot clinical case study presented the feasibility of our computer-aided surgical navigation system. According to the accuracy evaluation experiment, the precision of customized implant installation can be improved three to five times (TRE: 0.75 ± 0.18 mm) compared with the non-navigated implant installation after the guided osteotomy (TRE: 3.13 ± 1.28 mm), which means it is sufficient to meet the clinical requirements of the pelvic reconstruction. However, more clinical trials will be conducted in the future work for the validation of the reliability and efficiency of our navigation system.