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Unique Patients, Unique Challenges

Oncology, revision, osteotomy and other complex cases provide special challenges to the orthopaedic surgeon. Anatomy can be affected in an endless number of ways, making standard, off-the-shelf implants poorly suited for complex cases.

Now, Bodycad OnCallTM is making personalized, individually manufactured orthopaedic restorations a reality.

Bodycad OnCallTM gives surgeons unprecedented flexibility in design and manufacturing of a fully personalized restoration.1 Bodycad OnCallTM supports :


Multi-color Anatomical Modeling

Personalized Guided Resections

Complex Osteotomies

Oncology

Advanced Revisions

Every Bodycad OnCallTM personalized orthopaedic restoration matches the anatomical needs of the patient to reestablish durable form and function.

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A PREP TechTM is standing ready to assist the orthopaedic surgeons on the best approach for their patient. Please call a PREP TechTM at +1 (418) 527-1388 or email at oncall@bodycad.com to set up a Bodycad OnCallTM consultation.

Bodycad OnCall Brochure
Hip and Knee Tumor Imaging Guide

Bodycad OnCallTM Library

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Anatomical models

Posterior Knee Tumor
Posterior Knee Tumor with Guide
Mid-shaft Femur Tumor with Guide
Pelvic Tumor
Pelvic Tumor with Guide
Proximal Tibia Tumor
Proximal Tibial Tumor with Guide

Abstracts

Sarcoma Volume 2013 (2013), Article ID 787653, 7 pages
Surgical Guides (Patient-Specific Instruments) for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction Laura Bellanova, Laurent Paul and Pierre-Louis Docquier

To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

ISOLS MSTS 2015 Presentation 20 - Abstract #11257
Patient-Specific 3D-Printed Registration And Cutting Guides For Hemicortical Resection And Reconstruction Of Metaphyseal Tumors Around The Knee SEGURA FM, PEDEMONTE F, SEGURA FP and SEGURA FV

INTRODUCTION
Some benign aggressive tumors and low grade malignant tumors can be resected with close margins without compromising the patient´s oncological evolution. When these tumors are located in the distal femur or proximal tibia, they compromise the knee joint.
Hemi cortical resection, instead of intercalary or osteoarticular allows to save the articular surfaces, the bone stock and the opposite cortical continuity. Intra-surgical navigation has improved precision of the cuts performed in a tridimensional space. In this paper, we explore the combined use of Surgical Navigation with 3D-printed registration and cutting guides
The objective of this paper is to report the use of surgical navigation, registration and cutting guides for hemi cortical marginal resection and allograft reconstruction of metaphyseal tumors around the knee.
MATERIAL AND METHODS
MATERIAL
3 patients were treated during the study, 2 presenting parosteal osteosarcoma in the distal femur and 1 presenting a peripheral chondrosarcoma in the proximal tibia. The patients presenting parosteal osteosarcoma were females aged 18 and 29 years old and the patient with peripheral chondrosarcoma was a 24-year-old male. CT and MRI images were fused and processed and 3D-models were created. They served as a basis for the virtual simulation of the surgery, which was performed in the Mimics Innovation Suite (Materialise NV). Once the simulation was satisfactory, the results were used to digitally compare and select the optimal allograft. After this, two guides were designed and 3D-printed: a patientspecific and an allograft-specific registration and cutting guide. The cutting planes derived from the planning, as well as the CT and MRI images were loaded into a Stryker Intellect ComputerAssisted Surgical Navigation System.
The registration and cutting guides were fully matched with the coordinate system and landmark points generated inside the Navigation System´s software.
METHOD
In all the cases a virtual planning was performed through CT and MRI images fusion and 3D modelling of the lesion.
The guides were designed based on the virtual planning giving the possibility to cut 5 mm and 10 mm away from the tumor margin. Prior to the surgery, 3D printed biomodels were used to physically perform the surgery on them. That allowed to check the performance of the guides regarding margins accuracy and integration with the Surgical Navigation System. The tumor is reached by a conventional approach. Once the guide is properly positioned, five (5) landmarks are touched with a smart pointer in order to match specially the Navigation System´s reference frame with the bone reference frame. Once this was performed, it was possible to navigate the femur or the tibia and locate the resection planes. The jigs contain, grooves located so as to guide the blade along the resection planes. After the tumor resection, the same procedure was repeated in the allograft. The reconstruction was made with the allograft, stabilized by means of conventional plates and screws.
RESULTS
In the three cases the margin was free of tumor, both at macro and microscopic level and never less than 1 mm, according to the original plan. There were no postoperative complications registered and the patients were allowed to walk with full load in the treated limb 4 months after the procedure. At the assessment time every graft showed integrated and the functional MSTS score average was 28.
DISCUSSION
The current challenge in bone tumor surgery is to resect the least amount of tissue of the host in order to preserve the maximum function possible. In some tumors marginal resection is a good option without compromising the oncological evolution. In low grade malignancies near the knee is possible the resection of only one cortex, preserving the articular cartilage, bone stock and the continuity of the opposite cortex. The use of navigation in this situation has allowed planned bone cuts with better precision. The medical images and 3D reconstruction models allow the surgeon to do cuts according to what was previously planned. In hemicortical resections the use of cutting guides allows a resection according to the planning with a precision of 1mm. In addition the guides allow a more exact matching when the reconstruction is made with allograft bone.
CONCLUSIONS
The use of Patient-Specific Custom-Made cutting guides in tumor resection and allograft reconstruction around the knee allows marginal resections, with optimal morphological matching between the allograft and host bone.

Sarcoma Volume 2014 (2014), Article ID 842709, 9 pages
Computer-Assisted Planning and Patient-Specific Instruments for Bone Tumor Resection within the Pelvis: A Series of 11 Patients François Gouin, Laurent Paul, Guillaume Anthony Odri and Olivier Cartiaux

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins.

WHO/IARC
WHO Classification of Bone Tumours: Introduction H.D. Dorfman, B. Czerniak, R. Kotz, D. Vanel, Y.K. Park and K.K. Unni

Imaging of Bone Tumors and Tumor-Like Lesions 2009, XII, 701p. ISBN 978-3-540-77982-7
Bone Tumors: Epidemiology, Classification, Pathology Lars Gunnar Kindblom