{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T09:34:34Z","timestamp":1763544874503},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The treatment of locally aggressive bone tumors is a balance between achieving local tumor control and surgical morbidity. Wide resection decreases the likelihood of local recurrence, although wide resection may result in more complications than would happen after curettage. Navigation-assisted surgery may allow more precise resection, perhaps making it possible to expand the procedure\u2019s indications and decrease the likelihood of recurrence; however, to our knowledge, comparative studies have not been performed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Questions\/purposes<\/jats:title>\n            <jats:p>The purpose of this study was to compare curettage plus phenol as a local adjuvant with navigation-guided en bloc resection in terms of (1) local recurrence; (2) nononcologic complications; and (3) function as measured by revised Musculoskeletal Tumor Society (MSTS) scores.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Patients with a metaphyseal and\/or epiphyseal locally aggressive primary bone tumor treated by curettage and adjuvant therapy or en bloc resection assisted by navigation between 2010 and 2014 were considered for this retrospective study. Patients with a histologic diagnosis of a primary aggressive benign bone tumor or low-grade chondrosarcoma were included. During this time period, we treated 45 patients with curettage of whom 43 (95%) were available for followup at a minimum of 24 months (mean, 37 months; range, 24-61 months), and we treated 26 patients with navigation-guided en bloc resection, of whom all (100%) were available for study. During this period, we generally performed curettage with phenol when the lesion was in contact with subchondral bone. We treated tumors that were at least 5 mm from the subchondral bone, such that en bloc resection was considered possible with computer-assisted block resection. There were no differences in terms of age, gender, tumor type, or tumor location between the groups. Outcomes, including allograft healing, nonunion, tumor recurrence, fracture, hardware failure, infection, and revised MSTS score, were recorded. Bone consolidation was defined as complete periosteal and endosteal bridging visible between the allograft-host junctions in at least two different radiographic views and the absence of pain and instability in the union site. All study data were obtained from our longitudinally maintained oncology database.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In the curettage group, two patients developed a local recurrence, and no local recurrences were recorded in patients treated with en bloc resection. All patients who underwent navigation-guided resection achieved tumor-free margins. Intraoperative navigation was performed successfully in all patients and there were no failures in registration. Postoperative complications did not differ between the groups: in patients undergoing curettage, 7% (three of 43) and in patients undergoing navigation, 4% (one of 26) had a complication. There was no difference in functional scores: mean MSTS score for patients undergoing curettage was 28 points (range, 27\u201330 points) and for patients undergoing navigation, 29 (range, 27-30 points; p = 0.10).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In this small comparative series, navigation-assisted resection techniques allowed conservative en bloc resection of locally aggressive primary bone tumors with no local recurrence. Nevertheless, with the numbers available, we saw no difference between the groups in terms of local recurrence risk, complications, or function. Until or unless studies demonstrate an advantage to navigation-guided en bloc resection, we cannot recommend wide use of this novel technique because it adds surgical time and expense.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence<\/jats:title>\n            <jats:p>Level III, therapeutic study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000054","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T16:11:12Z","timestamp":1524845472000},"page":"511-517","source":"Crossref","is-referenced-by-count":10,"title":["Is Navigation-guided En Bloc Resection Advantageous Compared With Intralesional Curettage for Locally Aggressive Bone Tumors?"],"prefix":"10.1097","volume":"476","author":[{"given":"Germ\u00e1n L.","family":"Farfalli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose I.","family":"Albergo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas S.","family":"Piuzzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel A.","family":"Ayerza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Luis","family":"Muscolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas E.","family":"Ritacco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis A.","family":"Aponte-Tinao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2018,2,13]]},"reference":[{"key":"R1-20231015","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s11999-014-3604-z","article-title":"Does intraoperative navigation assistance improve bone tumor resection and allograft reconstruction results?","volume":"473","author":"Aponte-Tinao","year":"2014","journal-title":"Clin Orthop Relat Res."},{"key":"R2-20231015","doi-asserted-by":"crossref","first-page":"e325","DOI":"10.3928\/01477447-20130222-21","article-title":"Multiplanar osteotomies guided by navigation in chondrosarcoma of the knee","volume":"36","author":"Aponte-Tinao","year":"2013","journal-title":"Orthopedics"},{"key":"R3-20231015","doi-asserted-by":"crossref","first-page":"678","DOI":"10.5435\/00124635-201111000-00004","article-title":"Osteoid osteoma and osteoblastoma","volume":"19","author":"Atesok","year":"2011","journal-title":"J Acad Orthop Surg."},{"key":"R4-20231015","doi-asserted-by":"crossref","first-page":"2754","DOI":"10.1007\/s11999-010-1362-0","article-title":"Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas","volume":"468","author":"Avedian","year":"2010","journal-title":"Clin Orthop Relat Res."},{"key":"R5-20231015","doi-asserted-by":"crossref","first-page":"2845","DOI":"10.1007\/s11999-009-0913-8","article-title":"Joint preservation after extensive curettage of knee giant cell tumors","volume":"467","author":"Ayerza","year":"2009","journal-title":"Clin Orthop Relat Res."},{"key":"R6-20231015","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/jso.21105","article-title":"Osteoblastoma: a 30-year study of 99 cases","volume":"98","author":"Berry","year":"2008","journal-title":"J Surg Oncol."},{"key":"R8-20231015","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1002\/(SICI)1097-0142(19981115)83:10<2105::AID-CNCR9>3.0.CO;2-U","article-title":"Primary chondrosarcoma of long bones and limb girdles","volume":"83","author":"Bj\u00f6rnsson","year":"1998","journal-title":"Cancer"},{"key":"R9-20231015","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/107327481101800304","article-title":"Computer-assisted navigation and musculoskeletal sarcoma surgery","volume":"18","author":"Cheong","year":"2011","journal-title":"Cancer Control."},{"key":"R10-20231015","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1302\/0301-620X.94B10.28638","article-title":"The outcomes of navigation-assisted bone tumour surgery: minimum three-year follow-up","volume":"94","author":"Cho","year":"2012","journal-title":"J Bone Joint Surg Br."},{"key":"R11-20231015","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5435\/JAAOS-21-04-225","article-title":"Chondroma, chondroblastoma and chondromyxoid fibroma","volume":"21","author":"De Mattos","year":"2013","journal-title":"J Acad Orthop Surg."},{"key":"R13-20231015","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199301000-00035","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","volume":"286","author":"Enneking","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R14-20231015","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1002\/1097-0142(197708)40:2<818::AID-CNCR2820400234>3.0.CO;2-B","article-title":"Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading","volume":"40","author":"Evans","year":"1977","journal-title":"Cancer"},{"key":"R15-20231015","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3109\/17453674.2014.950800","article-title":"Computer-assisted surgery in orthopedic oncology","volume":"85","author":"Gerbers","year":"2014","journal-title":"Acta Orthop"},{"key":"R16-20231015","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.2106\/00004623-198163080-00006","article-title":"Chondrosarcoma of bone. The experience at the Istituto Ortopedico Rizzoli","volume":"63","author":"Gitelis","year":"1981","journal-title":"J Bone Joint Surg Am."},{"key":"R17-20231015","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1007\/s11999-011-2190-6","article-title":"Intralesional excision versus wide resection for giant cell tumor involving the acetabulum: which is better?","volume":"470","author":"Guo","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"R18-20231015","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/01.blo.0000138958.11939.94","article-title":"New indications for computer-assisted surgery: tumor resection in the pelvis","volume":"426","author":"H\u00fcfner","year":"2004","journal-title":"Clin Orthop Relat Res."},{"key":"R19-20231015","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s11999-010-1501-7","article-title":"Giant cell tumor of bone: risk factors for recurrence","volume":"469","author":"Klenke","year":"2011","journal-title":"Clin Orthop Relat Res."},{"key":"R20-20231015","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/01.blo.0000174685.62379.6a","article-title":"Chondromyxoid fibroma: a rarely encountered and puzzling tumor","volume":"439","author":"Lersundi","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R21-20231015","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/01.blo.0000179591.72844.c3","article-title":"Treatment and prognosis of chondroblastoma","volume":"438","author":"Lin","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"R22-20231015","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/0046-8177(94)90267-4","article-title":"Osteoblastoma: clinicopathologic study of 306 cases","volume":"25","author":"Lucas","year":"1994","journal-title":"Hum Pathol."},{"key":"R23-20231015","doi-asserted-by":"crossref","first-page":"6756","DOI":"10.1200\/JCO.2005.15.255","article-title":"Aneurysmal bone cyst: a review of 150 patients","volume":"23","author":"Mankin","year":"2005","journal-title":"J Clin Oncol."},{"key":"R24-20231015","doi-asserted-by":"crossref","first-page":"292","DOI":"10.5435\/00124635-200009000-00003","article-title":"Cartilage tumors: evaluation and treatment","volume":"8","author":"Marco","year":"2000","journal-title":"J Am Acad Orthop Surg."},{"key":"R25-20231015","doi-asserted-by":"crossref","first-page":"S119","DOI":"10.1016\/j.otsr.2014.06.031","article-title":"Bone cysts: Unicameral and aneurysmal bone cyst","volume":"101","author":"Mascard","year":"2015","journal-title":"Orthop Traumatol Surg Res."},{"key":"R26-20231015","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/BTO.0b013e31811f35d4","article-title":"Extended curettage for benign bone lesions","volume":"22","author":"McGarry","year":"2007","journal-title":"Tech Orthop."},{"key":"R28-20231015","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/1097-0142(197209)30:3<726::AID-CNCR2820300321>3.0.CO;2-T","article-title":"Chondromyxoid fibroma: a clinicopathologic study of 76 cases","volume":"30","author":"Rahimi","year":"1972","journal-title":"Cancer"},{"key":"R29-20231015","doi-asserted-by":"crossref","first-page":"233","DOI":"10.5435\/JAAOS-20-04-233","article-title":"Aneurysmal bone cyst","volume":"20","author":"Rapp","year":"2012","journal-title":"J Am Acad Orthop Surg"},{"key":"R30-20231015","doi-asserted-by":"crossref","first-page":"118","DOI":"10.5435\/JAAOS-21-02-118","article-title":"Giant cell tumor of bone","volume":"21","author":"Raskin","year":"2013","journal-title":"J Acad Orthop Surg"},{"key":"R31-20231015","doi-asserted-by":"crossref","first-page":"e942","DOI":"10.3928\/01477447-20130624-27","article-title":"Accuracy of 3-D planning and navigation in bone tumor resection","volume":"36","author":"Ritacco","year":"2013","journal-title":"Orthopedics"},{"key":"R32-20231015","first-page":"1162","article-title":"Bone tumor resection: analysis about 3D preoperative planning and navigation method using a virtual specimen","volume":"192","author":"Ritacco","year":"2013","journal-title":"Stud Health Technol Inform"},{"key":"R33-20231015","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3928\/01477447-20070101-08","article-title":"Low-grade cartilage tumors: diagnosis and treatment","volume":"30","author":"Ryzewicz","year":"2007","journal-title":"Orthopedics"},{"key":"R34-20231015","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.1007\/s11999-010-1465-7","article-title":"Computer-assisted navigation in bone tumor surgery: Seamless workflow model and evolution of technique","volume":"468","author":"So","year":"2010","journal-title":"Clin Orthop Relat Res."},{"key":"R35-20231015","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1302\/0301-620X.87B7.16009","article-title":"Chondroblastoma of bone: long-term results and functional outcome after intralesional curettage","volume":"87","author":"Suneja","year":"2005","journal-title":"J Bone Joint Surg Br."},{"key":"R36-20231015","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s40137-014-0047-0","article-title":"Use of computer navigation in orthopedic oncology","volume":"2","author":"Wong","year":"2014","journal-title":"Curr Surg Rep."},{"key":"R37-20231015","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1302\/0301-620X.89B7.19067","article-title":"Precision tumour resection and reconstruction using image-guided computer navigation","volume":"89","author":"Wong","year":"2007","journal-title":"J Bone Joint Surg Br."},{"key":"R38-20231015","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1302\/0301-620X.97B2.34461","article-title":"The evolving role of computer-assisted navigation in musculoskeletal oncology","volume":"97","author":"Young","year":"2015","journal-title":"Bone Joint J."},{"key":"R39-20231015","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1471-2482-14-52","article-title":"A multiplanar complex resection of a low-grade chondrosarcoma of the distal femur guided by K-wires previously inserted under CT-guide: a case report","volume":"14","author":"Zoccali","year":"2014","journal-title":"BMC Surg"}],"container-title":["Clinical Orthopaedics &amp; Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00003086-201803000-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T08:31:01Z","timestamp":1697358661000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00003086-201803000-00014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,13]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1007\/s11999.0000000000000054","relation":{},"ISSN":["0009-921X"],"issn-type":[{"value":"0009-921X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,13]]}}}