1. SARCOMA DIVISION Development of Computer Assisted Surgery for Orthopaedic Oncology Applications: Preliminary report of the first American Series David Cheong, Dylan Nugent, Eric R Henderson, German Marulanda, G Douglas Letson

2. SARCOMA DIVISION Disclosure: No financial support was received in the production of this presentation, data being presented, surgical procedures, or instrumentation

3. SARCOMA DIVISION Navigation

4. SARCOMA DIVISION

5. Computer Navigated Oncology Surgeries since 2008 6Distal Femur Replacement 3Internal Hemi-pelvectomy 2Proximal Tibia Replacement 1Proximal Femur Replacement 6Sacro-iliac Instrumentation Primary Malignant Bones Tumors Multiple Myeloma Benign Aggressive Bone Tumors Aggressive Soft Tissue Sarcoma Metastatic Disease

6. SARCOMA DIVISION

7. Image Based

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9. Navigated Cautery Pencil

10. SARCOMA DIVISION Navigated Osteotome

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12. Navigated Hemi-pelvectomy Plane Planning

13. SARCOMA DIVISION

14. Accuracy of Resection

15. SARCOMA DIVISION Limb Length

16. SARCOMA DIVISION Navigated Proximal Femur

17. SARCOMA DIVISION Finding anatomical structures for optimum screw placement Replicate screw dimensions – Head size – Length – Diameter Set head point and screw axis Multiple screw plans Screw Planning

18. SARCOMA DIVISION Screw Planning

19. SARCOMA DIVISION Navigated Screws

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21. Potential!!! Accuracy of Resection – Navigated instrumentation – Blending real time imaging Accuracy of Reconstruction – Re-establishing the joint line – Reducing limb length discrepancies Intra-operative Execution of the Pre-operative plan

22. SARCOMA DIVISION