Background: The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. Methods: The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. Results: Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. Conclusions: Overall, 3D technologies are gradually becoming an integral part of a surgeon’s preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.

Over the past four decades, advancements in adjuvant treatments of bone sarcomas have catalyzed development of novel surgical technologies that continue to improve limb salvage surgeries. To date, ...

Background: During pelvic Sarcoma resections, Surgeons often struggle to obtain negative margins while minimizing collateral damage and maintaining limb function. These complications are usually due to the complex anatomy of the pelvis. Here we present an accurate 3D surgical approach, including pre-operative printing of models and intraoperative patient-specific instruments (PSIs) for optimizing pelvic sarcoma resections. Methods: This single-center retrospective study (N = 11) presents surgical, functional, and oncological outcomes of patients (average age 14.6 +/− 7.6 years, 4 males) who underwent pelvic sarcoma resections using a 3D surgical approach between 2016 and 2021. All patients were followed up for at least 24 months (mean = 38.9 +/− 30.1 months). Results: Our results show promising surgical, oncological, and functional outcomes. Using a 3D approach, 90.9% had negative margins, and 63.6% did not require reconstruction surgery. The average estimated blood loss was 895.45 ± 540.12 cc, and the average surgery time was 3:38 ± 0.05 hours. Our results revealed no long-term complications. Three patients suffered from short-term complications of superficial wound infections. At 24 month follow up 72.7% of patients displayed no evidence of disease. The average Musculoskeletal Tumor Society (MSTS) score at 12 months was 22.81. Conclusion: 3D technology enables improved accuracy in tumor resections, allowing for less invasive procedures and tailored reconstruction surgeries, potentially leading to better outcomes in function and morbidity. We believe that this approach will enhance treatments and ease prognosis for patients diagnosed with pelvic sarcoma and will become the standard of care in the future.

Background and Objectives: To date, the gold standard of care for bone sarcomas is limb salvage surgical resection. In cases where the tumor arises in the distal femur or proximal tibia near the joint line, knee-sacrificing surgery is typically performed, followed by reconstruction with oncological megaprostheses. This study aims to evaluate the effectiveness of a precise 3D-based surgical approach for knee-sparing tumor resections, assessing its feasibility and its impact on surgical, oncological, and functional outcomes. Materials and Methods: This single-center retrospective study presents the surgical and oncological outcomes of knee-sparing surgeries following bone sarcoma resections. All patients underwent either intercalary or geographic resection, and reconstruction was tailored to each patient, using either an allograft or a titanium alloy Ti64 implant, depending on the specific requirements of the case. Results: A total of 23 patients (average age 21.04 years, 14 males) were included, with an average postoperative follow-up of 58 months (range: 12–102 months). Clear surgical margins were achieved in all patients, with 16 patients (69.5%) showing wide negative margins (R0) and the rest showing close negative margins (R1). Resections were primarily intercalary (17 patients, 73.9%), with 6 patients (26.1%) undergoing geographic resections. Reconstruction methods included allografts (9 patients, 39.3%), vascularized fibula and allograft (8 patients, 34.7%), and printed Ti64 cage reconstructions (6 patients, 26.0%). At the last follow-up, 19 patients (82.6%) were disease-free, 3 patients (13.4%) were alive with evidence of disease, and 1 patient (4%) was dead of disease. Complications included four cases of non-union that required revision surgery, as well as two local recurrences, which necessitated revision surgery to a modular endoprosthesis and above-knee amputation. The average MSTS at the final follow-up was 23.16 ± 5.91. Conclusions: The use of 3D-printed PSIs for knee-sparing bone tumor resections has emerged as the gold standard, enhancing both surgical and oncological outcomes. A future challenge lies in improving reconstruction techniques, shifting from traditional allografts to customized Ti64 printed lattice implants. As personalized healthcare and additive manufacturing continue to advance, the future of orthopedic oncology will likely see more precise, durable, and biologically integrated implants, further improving patient outcomes.