# Patent

## Title
Pre-operative planning and manufacturing method for orthopedic procedure

## Abstract

A pre-operative planning and manufacturing method for orthopedic surgery includes obtaining pre-operative medical image data representing a joint portion of a patient. The method also includes constructing a three-dimensional digital model of the joint portion and manufacturing a patient-specific alignment guide for the joint portion from the three-dimensional digital model of the joint portion when the image data is sufficient to construct the three-dimensional digital model of the joint portion. The patient-specific alignment guide has a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion. The method further includes determining, from the image data, a size of a non-custom implant to be implanted in the patient and manufacturing the non-custom implant when there is insufficient image data to construct the patient-specific alignment guide therefrom.

## Background
INTRODUCTION
The present teachings provide various methods of pre-operative planning and manufacturing for orthopedic procedures.
SUMMARY
The present teachings provide a pre-operative planning and manufacturing method for orthopedic surgery. The method includes obtaining pre-operative medical image data representing a joint portion of a patient. The method also includes constructing a three-dimensional digital model of the joint portion and manufacturing a patient-specific alignment guide for the joint portion from the three-dimensional digital model of the joint portion when the image data is sufficient to construct the three-dimensional digital model of the joint portion. The patient-specific alignment guide has a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion. The method further includes determining, from the image data, a size of a non-custom implant to be implanted in the patient and manufacturing the non-custom implant when there is insufficient image data to construct the patient-specific alignment guide therefrom.
A pre-operative planning and manufacturing method for orthopedic surgery is also disclosed. The method includes pre-operatively obtaining medical image data that is readable on a computer. The medical image data contains a plurality of two-dimensional medical images of a joint portion of a patient. The method also includes pre-operatively constructing a three-dimensional digital model of the joint portion from the plurality of two-dimensional medical images and displaying the three-dimensional digital model on a display of the computer when the plurality of two-dimensional medical images are sufficient to construct the three-dimensional digital model of the joint portion. Furthermore, the method includes selecting, based on the image data, a non-custom implant to be implanted in the patient and providing the non-custom implant when the plurality of two-dimensional medical images are insufficient for use in constructing a patient-specific alignment guide having a three-dimensional patient-specific surface configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion. The non-custom implant is chosen from a group of non-custom implants of different sizes.
Moreover, a computerized pre-operative planning tool for planning an orthopedic surgical procedure is disclosed. The tool includes a receiver device that receives medical image data containing a plurality of two-dimensional medical images of a joint portion of a patient. The tool also includes a processor that determines whether the medical image data is sufficient for constructing a three-dimensional digital model of the joint portion from the plurality of two-dimensional medical images. The processor is additionally configured to construct the three-dimensional digital model when the medical image data is sufficient to construct the three-dimensional digital model. The processor is further configured to construct a patient-specific digital model of a patient-specific alignment guide when the medical image data is sufficient to construct the three-dimensional digital model. The patient-specific alignment guide has a three-dimensional surface that nests against a corresponding surface of the three-dimensional digital model of the joint portion. Additionally, the tool includes a display that displays the three-dimensional digital model of the joint portion and the patient specific digital model of the patient-specific alignment guide when the processor determines that the medical image data is sufficient for constructing the three-dimensional digital model of the joint portion. The display also displays at least one of the two-dimensional medical images of the joint portion for selection of a non-custom implant when the processor determines that the medical image data is insufficient for constructing the patient-specific alignment guide therefrom.
Still further, a pre-operative planning and manufacturing method for orthopedic surgery of a knee joint of a patient is disclosed. The method includes obtaining pre-operative medical image data representing the knee joint, wherein the medical image data includes a plurality of two-dimensional images of the knee joint. The method also includes constructing a three-dimensional digital model of the knee joint and manufacturing a patient-specific alignment guide for the knee joint from the three-dimensional digital model of the knee joint when the plurality of two-dimensional images of the knee joint is sufficient to construct the three-dimensional digital model of the knee joint. The patient-specific alignment guide has a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the knee joint of the patient in only one position relative to the knee joint. The method also includes determining, based on at least one of the two-dimensional images of the knee joint, a size of a non-custom implant to be implanted in the knee joint of the patient when there is insufficient image data to construct the patient-specific alignment guide therefrom. Additionally, the method includes determining a dimension for a non-custom surgical instrument configured for implanting the non-custom implant when there is insufficient image data to construct the patient-specific alignment guide therefrom. Moreover, the method includes manufacturing at least one of the non-custom implant and the non-custom surgical instrument when there is insufficient image data to construct the patient-specific alignment guide therefrom. Furthermore, the method includes assembling a kit containing the non-custom implant and the non-custom surgical instrument when there is insufficient image data to construct the patient-specific alignment guide therefrom.
Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.



BRIEF DESCRIPTION OF THE DRAWINGS
The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:
FIG. 1 is a schematic illustration of a pre-operative planning tool according to various exemplary embodiments of the present teachings;
FIG. 2 is a flowchart of a method of a pre-operative planning and manufacturing method according to various exemplary embodiments of the present teachings;
FIG. 3 is a two-dimensional image of a knee joint used in the pre-operative planning methods of the present teachings;
FIG. 4A is a three-dimensional digital model of a femur with a patient-specific alignment guide according to the present teachings;
FIG. 4B is a three-dimensional digital model of a tibia with a patient-specific alignment guide according to the present teachings;
FIG. 5 is an isometric view of a femoral component of a knee prosthesis; and
FIG. 6 is a schematic illustration of a kit containing components for implanting a knee prosthesis.



DESCRIPTION OF VARIOUS ASPECTS
The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses. For example, although some of the present teachings are presented in relation to surgical planning for implanting a knee joint prosthesis, the present teachings can be employed for planning surgical implantation of any prosthetic device.
The present teachings provide various pre-operative planning methods for orthopedic procedures. For instance, the present teachings can be employed for planning partial or total knee joint replacement surgery. Specifically, image data from medical scans of the patient can be provided, and if there is sufficient two-dimensional image data, an accurate three-dimensional digital model of the knee joint can be generated as well as a three-dimensional digital model of a patient-specific alignment guide. If there is insufficient two-dimensional image data to generate the three-dimensional digital model and a patient-specific alignment guide therefrom, the image data can still be used to determine a size of a non-custom prosthesis to be implanted. The image data can also be used to determine sizes and dimensions for instruments (e.g., resection guides, etc.) that will be used during surgery. Moreover, a kit can be pre-operatively assembled containing the selected alignment guide(s), prosthetic device(s), trial prosthetic device(s), instruments, etc. that will be used during surgery for a particular patient. These methods can, therefore, make pre-operative planning more efficient. Also, the surgical procedure can be more efficient since the prosthetic device and the related surgical implements can be tailored for the particular patient.
Referring initially to FIG. 1, a pre-operative planning tool 10 is illustrated. The tool 10 can be computer-based and can generally include a receiving device 12, a processor 14, a memory device 16, and a display 18.
The receiving device 12 can receive medical image data 20 of a joint portion 24 (e.g., a knee joint) of a patient. Representative image data 20 of a knee joint portion 24 (including a femur F and a tibia T) of a patient is illustrated in FIG. 3. It will be appreciated that the image data 20 can include any number of images of the joint portion 24, taken from any viewing perspective.
Specifically, the receiving device 12 can receive medical scans prepared by a Magnetic Resonance Imaging (MRI) device, a Computed Tomography (CT) scanner, a radiography or X-ray machine, an ultrasound machine, a camera or any other imaging device 22. The imaging device 22 can be used to generate electronic (e.g., digital) image data 20. The image data 20 can be stored on a physical medium, such as a CD, DVD, flash memory device (e.g. memory stick, compact flash, secure digital card), or other storage device, and this data 20 can be uploaded to the tool 10 via a corresponding drive or other port of the receiving device 12. The image data 20 may alternatively, or in addition, be transmitted electronically to the receiving device 12 via the Internet or worldwide web using appropriate transfer protocols. Also, electronic transmissions can include e-mail or other digital transmission to any appropriate type of computer device, smart phone, PDA or other devices in which electronic information can be transmitted.
The memory device 16 can be of any suitable type (RAM and/or ROM), and the medical image data 20 can be inputted and stored in the memory device 16. The memory device 16 can also store any suitable software and programmed logic thereon for completing the pre-operative planning discussed herein. For instance, the memory device 16 can include commercially-available software, such as software from Materialise USA of Plymouth, Mich.
The processor 14 can be of a known type for performing various calculations, analyzing the data, and other processes discussed hereinbelow. Also, the display 18 can be a display of a computer terminal or portable device, such as an electronic tablet, or any other type of display. As will be discussed, the display 18 can be used for displaying the medical image data 20 and/or displaying digital anatomical models generated from the image data 20 and/or displaying other images, text, graphics, or objects.
It will also be appreciated that the pre-operative planning tool 10 can include other components that are not illustrated. For instance, the planning tool 10 can include an input device, such as a physical or electronic keyboard, a joystick, a touch-sensitive pad, or any other device for inputting user controls.
As will be discussed, the image data 20 can be analyzed and reviewed (manually or automatically) using the tool 10 to determine whether the image data 20 is sufficient enough to generate and construct a three-dimensional (3-d) digital model 26a, 26b of the joint 24. (A representative 3-d digital model 26a of the patient's femur F is illustrated in FIG. 4A, and a representative 3-d digital model 26b of the patient's tibia T is illustrated in FIG. 4B.)
For instance, if the image data 20 was collected by MRI or other higher-resolution imaging device, there are likely to be a relatively large number of two-dimensional images of the joint 24 taken at different anatomical depths, and these images can be virtually assembled (“stacked”) by the processor 14 to generate the three-dimensional electronic digital model 26a, 26b of the patient's anatomy. Using these digital models 26a, 26b, a first surgical plan 30 (FIG. 1) can be generated, and a corresponding kit 33 can be manufactured and assembled. As will be discussed, the kit 33 can include the physical components necessary for surgery, including patient-specific alignment guide(s), selected prosthetic devices, trial prosthetic devices, surgical instruments, and more. The kit 33 can be sterilized and shipped to be available for surgery for that particular patient.
However, if the image data 20 was collected by X-ray or other lower-resolution imaging device, there is unlikely to be sufficient data about the joint 24 to generate accurate three-dimensional digital models 26a, 26b. Regardless, the two-dimensional image data 20 can still be used to generate a second surgical plan 32 as shown in FIG. 1, and a corresponding kit 34 can be assembled. The kit 34 can include a selected non-patient-specific (non-custom) implant, trial implant, surgical instruments, and more. However, the items within the kit 34 can be size-specific (i.e., the size of the items in the kit 34 can be pre-operatively selected for the particular patient).
It will be appreciated that the same tool 10 can be used for planning purposes, regardless of whether the image data 20 is sufficient to generate three-dimensional digital models of the joint 24 or not. Thus, for instance, if the patient is able and willing to undergo MRI to obtain highly detailed images as recommended by the surgeon, the tool 10 can be used to generate a surgical plan 30 and to manufacture implements that are highly customized for that patient. Otherwise, if the patient is unable or unwilling to undergo MRI (e.g., because the patient has a pacemaker, because the patient has claustrophobia, because MRI is not recommended by the surgeon, etc.), the tool 10 can still be used to generate the surgical plan 32, albeit with implements that are selected from inventory or manufactured on a non-custom basis. In either case, the surgery can be planned and carried out efficiently.
Referring now to FIG. 2, a method 40 of using the tool 10 will be discussed. The method 40 can begin in block 42, in which the image data 20 is obtained. As mentioned above, the image data 20 can be obtained from an MRI device, an X-ray device, or the like. In the case of data 20 obtained by X-ray, one or more radio-opaque (e.g., magnetic) markers or scaling devices 43 can be used as shown in FIG. 3. These devices 43 can be of a known size and shape. For instance, the devices 43 can be discs that measure ten centimeters in diameter, or the devices 43 can be elongate strips or other shapes with known dimensions. The devices 43 can be placed over the patient's knee joint 24 before the X-ray is taken. The devices 43 will be very visible in the X-ray image. Since the actual size of the devices 43 are known, the size of the device 43 can be compared against the anatomical measurements taken from the image, and the scale of anatomy in the image can be thereby detected.
Next, as shown in FIG. 2, the method 40 can continue in block 44, in which the image data 20 can be evaluated, and in block 46, it can be determined whether there is enough data to generate accurate 3-d digital model(s) 26a, 26b of the joint 24. “Accurate” in this context means that the image data 20 is sufficient and detailed enough to generate precise representations of the anatomical joint 24. More specifically, “accurate 3-d models” are those that are detailed and precise enough to construct a patient-specific alignment guide therefrom. (Patient-specific alignment guides will be discussed in greater detail below.) It is noted that three 3-d models can still be generated from a lesser or insufficient number of medical scans, although such 3-d models will not be accurate enough to generate patient-specific alignment guides that mirror the corresponding joint surfaces of the specific patients.
In some embodiments, the processor 14 can analyze the data 20 to automatically determine if it is sufficient to model the complex, three-dimensionally curved surfaces of the distal end of the femur F and the proximate end of the tibia T. In other embodiments, the tool 10 can automatically detect whether the data 20 is MRI data (higher-resolution data) or X-ray data (lower-resolution data). If the data 20 is MRI data, then the digital models 26a, 26b can be generated and block 46 is answered affirmatively. If the data 20 is X-ray data, then the digital models 26a, 26b cannot be generated and block 46 is answered negatively.
If decision block is answered in the affirmative, then block 48 follows, and the digital models 26a, 26b are generated as represented in FIGS. 4A and 4B. These digital models 26a, 26b can be displayed on the display 18. Subsequently in block 49, the first surgical plan 30 is generated. Specifically, various dimensions of the femur F and tibia T can be automatically detected from the digital models 26a, 26b, the mechanical axis of the joint 24 can be detected from the digital models 26a, 26b, resection plane(s) for the femur F and tibia T can be planned according to the digital models 26a, 26b, soft tissue can be analyzed in the digital models, etc. A prosthetic implant assembly 60 (FIG. 6) can then be selected and/or designed according to this analysis.
More specifically, as shown in FIG. 6 various inventories 70, 72 of differently sized prosthetic implant assemblies 60 can be provided. The inventory 70 can include components for a full knee replacement, and the inventory 72 can include components for a partial knee replacement. From the digital models 26a, 26b, the surgeon can decide to do a full knee replacement, as represented in FIG. 6. From the digital models 26a, 26b, the surgeon can also determine the size of the prosthetic implant assembly 60 that is appropriate for the patient. Thus, the surgeon can determine the size and other appropriate features for a femoral component 62, a tibial component 64 (tibial tray), a bearing 66, and one or more fasteners 68 for the patient. Each of these components 62, 64, 66, 68 can be individually selected from the inventory 70.
In some embodiments, the prosthetic implant assembly 60 can be selected from non-custom, inventoried components of the commercially-available VANGUARDTM complete knee system of Biomet, Inc. of Warsaw, Ind. The surgeon also has the option of selecting components from the other inventory 72, such as partial knee prosthetic implants of the OXFORDTM partial knee system of Biomet, Inc. of Warsaw, Ind. In still other cases, the surgeon can design a patient-specific prosthetic implant (i.e., one that is customized, non-inventoried, and intended for a single patient). In any case, the surgeon can rely on the digital models 26a, 26b for selecting and/or designing the most appropriate implant assembly 60 for restoring function of the joint 24. It will be appreciated that the prosthetic implant assembly 60 can be selected from any one of various types, such as bilateral or unilateral implants, constrained, semi-constrained, mobile types, etc. It will also be appreciated that the components 62, 64, 66, 68 may not be stocked in inventory, and the components 62, 64, 66, 68 can be manufactured on-demand.
A resection guide 80 can also be selected from an inventory 82 of different resection guides of different sizes and dimensions. The resection guide 80 can include one or more guide surfaces (e.g., grooves, or slots) used for guiding a resection tool while resecting the bones F, T. The resection guide 80 can be selected such that the resection plane(s) will be located as determined in block 49. The resection guide 80 can be of any suitable type, such as a 4-in-1 femoral cut block, which is commercially available from Biomet, Inc. of Warsaw, Ind. Resection guides can also be selected for resecting the tibia T as well.
Once the surgical plan has been generated in block 49, block 50 follows as shown in FIG. 2. In block 50, patient-specific alignment guides 36a, 36b (FIGS. 4A and 4B) can be designed according to the anatomical digital models 26a, 26b and according to the prosthetic implant assembly 60 selected in block 49. Patient-specific alignment guides 36a, 36b and their method of manufacture are disclosed and described in detail in the commonly-owned, co-pending U.S. patent application Ser. No. 11/756,057, filed on May 31, 2007, and published as U.S. Patent Publication No. 2007/0288030, which is hereby incorporated herein by reference in its entirety. The femoral alignment guide 36a can be configured to include a three-dimensional patient-specific surface 52a that nests and closely conforms to a corresponding surface 51a of the distal femur F in only one position (with or without articular cartilage). Likewise, the tibial alignment guide 36b can be configured to include a three-dimensional patient-specific surface 52b that nests and closely conforms to a corresponding surface 51b of the proximal tibia T in only one position (with or without articular cartilage). Furthermore, the alignment guides 36a, 36b can each be designed to include respective alignment holes 54a, 54b at predetermined locations relative to the bones F, T. The alignment holes 54a, 54b can be positioned relative to the bones F, T for aligning surgical instruments (drill guides, resection guides, etc.).
Next, in block 53, the alignment guides 36a, 36b can be manufactured. The digital models 26a, 26b can be used to automatically generate computer instructions of tool paths for machining the patient-specific alignment guide(s) 36a, 36b. These instructions can be stored in a tool path data file and provided as input to a CNC mill or other automated maching system, and the alignment guides 36a, 36b can be machined from polymer, ceramic, metal or other suitable material, and sterilized. The sterilized alignment guides 36a, 36b can be shipped to the surgeon or medical facility for use during the surgical procedure. The alignment guides 36a, 36b can also be manufactured out of a polymer or other material using known rapid-prototyping machines and techniques. Also, in block 53, the components of the prosthetic implant assembly 60 selected in block 49 can be manufactured. These components can be made from a biologically compatible material (e.g., Titanium), and can be manufactured by casting and polishing manufacturing methods. In other embodiments, the method 40 can skip block 53 because the prosthetic implant assembly 60 has been previously manufactured and the assembly 60 is simply obtained from inventory. Trial prosthetics (e.g., prosthetic components that are temporarily implanted as a test during surgery) can also be manufactured in block 53.
Finally, in block 59, the kit 33 containing all of the previously-selected components is assembled for the particular patient. As mentioned above with respect to FIG. 1, the kit 33 can include the patient-specific alignment guides 36b, the prosthetic implant assembly 60 selected in block 49, trial prosthetics, resection guides and other instruments, etc. The kit 33 can be sterilized and shipped to the surgeon or surgical facility for surgery. Accordingly, the planning tool 10 and its method 40 of use can be highly effective for tailoring the surgery to the particular patient, and the proper components are very likely to be available during surgery.
Referring back to block 46, if the image data 20 is insufficient for generating an accurate 3-d digital models (i.e., block 46 answered negatively), then block 55 follows, and the second surgical plan 32 is generated according to the available 2-d image data 20. The image data 20 can be displayed on the display 18. Next, in block 56, the anatomy can be measured in order to select a non-custom implant that would be appropriate for the particular patient. For instance, as shown in FIG. 3, a condylar width W can be measured directly from the image data 20, and as shown in FIG. 5, a femoral component 62 with a width W closest to the measured width W can be selected from inventory 70 (FIG. 6) for implantation. Other anatomical dimensions and features of the anatomy can be similarly measured to identify the appropriate femoral component 62 for implantation. The tibia T can be similarly measured to identify the appropriate tibial component 64 and bearing 66. In some embodiments, 2-d templates can be generated and utilized according to the image data 20, and these templates can be used for selecting the components of the prosthetic implant assembly 60.
Subsequently, in block 58, a resection guide 80 can be selected from an inventory 82 of different resection guides of different sizes and dimensions. The resection guide 80 can be selected such that the resection plane(s) will be located as determined in block 55. The resection guide 80 can be of any suitable type, such as a 4-in-1 femoral cut block, which is commercially available from Biomet, Inc. of Warsaw, Ind. Resection guides can also be selected for resecting the tibia T as well. Other resection guides, including distal femoral cutting blocks, and/or other surgical instruments (drill guides, etc.) can be selected in a similar fashion in block 58.
Next, the components of the non-custom prosthetic implant assembly 60 can be manufactured in block 53. Alternatively, as discussed above, the components can be retrieved from inventory. Finally, the kit 34 containing the components of the implant assembly 60, a trial implant, surgical instruments can be assembled in block 59 and stored until the day of surgery.
In summary, the methods described above can streamline pre-operative planning because the surgery can be planned based on either 2-d or 3-d medical image data 20. The surgery, the prosthetic implant assembly 60 and surgical instruments can be tailored for the particular patient in an efficient and convenient fashion.
The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims.

## Claims

1. A pre-operative planning and manufacturing method for orthopedic surgery comprising:
obtaining pre-operative medical image data representing a joint portion of a patient;
constructing a three-dimensional digital model of the joint portion and manufacturing a patient-specific alignment guide for the joint portion from the three-dimensional digital model of the joint portion when the image data is sufficient to construct the three-dimensional digital model of the joint portion, the patient-specific alignment guide having a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion; and
determining, from the image data, a size of a non-custom implant to be implanted in the patient and manufacturing the non-custom implant when there is insufficient image data to construct the patient-specific alignment guide therefrom.

2. The method of claim 1, further comprising manufacturing a patient-specific implant after constructing the three-dimensional digital model of the joint portion.

3. The method of claim 1, wherein determining the size of the non-custom implant includes selecting the non-custom implant from a group of non-custom implants of different sizes.

4. The method of claim 1, further comprising determining, from the image data, a dimension of a non-custom surgical instrument configured for use during surgery for implanting the non-custom implant.

5. The method of claim 4, wherein the non-custom surgical instrument is a resection tool with a guide surface configured for guiding a cutting tool during resection of a bone of the joint portion.

6. The method of claim 4, further comprising selecting the non-custom surgical instrument from a plurality of non-custom surgical instruments of different dimensions.

7. The method of claim 1, further comprising manufacturing a trial implant that corresponds to the non-custom implant.

8. The method of claim 1, further comprising assembling a kit containing the non-custom implant, a non-custom surgical instrument configured for use during surgery for implanting the non-custom implant, and a trial implant that corresponds to the non-custom implant.

9. The method of claim 1, wherein the joint portion is a knee joint and the non-custom implant is at least one of a femoral implant and a tibial implant.

10. A pre-operative planning and manufacturing method for orthopedic surgery comprising:
pre-operatively obtaining medical image data that is readable on a computer, the medical image data containing a plurality of two-dimensional medical images of a joint portion of a patient;
pre-operatively constructing a three-dimensional digital model of the joint portion from the plurality of two-dimensional medical images and displaying the three-dimensional digital model on a display of the computer when the plurality of two-dimensional medical images are sufficient to construct the three-dimensional digital model of the joint portion and a corresponding a patient-specific alignment guide; and
selecting, based on the image data, a non-custom implant to be implanted in the patient and providing the non-custom implant when the plurality of two-dimensional medical images are insufficient for use in constructing a patient-specific alignment guide having a three-dimensional patient-specific surface configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion, the non-custom implant chosen from a group of non-custom implants of different sizes.

11. The method of claim 10, further comprising manufacturing the patient-specific alignment guide when the plurality of two-dimensional medical images are sufficient, the patient-specific alignment guide having a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the joint portion of the patient in only one position relative to the joint portion, and further comprising manufacturing the selected non-custom implant when the plurality of two-dimensional medical images are insufficient to construct the patient-specific alignment guide therefrom.

12. The method of claim 10, further comprising manufacturing a patient-specific implant after constructing the three-dimensional digital model of the joint portion.

13. The method of claim 10, further comprising determining, from the medical image data, a dimension of a non-custom surgical instrument configured for use during surgery for implanting the non-custom implant.

14. The method of claim 13, wherein the non-custom surgical instrument is a resection tool with a guide surface configured for guiding a cutting tool during resection of a bone of the joint portion.

15. The method of claim 13, further comprising selecting the non-custom surgical instrument from a plurality of non-custom surgical instruments of different dimensions.

16. The method of claim 10, further comprising manufacturing a trial implant that corresponds to the non-custom implant.

17. The method of claim 10, further comprising assembling a kit containing the non-custom implant, a non-custom surgical instrument configured for use during surgery for implanting the non-custom implant, and a trial implant that corresponds to the non-custom implant.

18. The method of claim 10, wherein the joint portion is a knee joint and the non-custom implant is at least one of a femoral implant and a tibial implant.

19. A computerized pre-operative planning tool for planning an orthopedic surgical procedure comprising:
a receiver device that receives medical image data containing a plurality of two-dimensional medical images of a joint portion of a patient;
a processor that determines whether the medical image data is sufficient for constructing a three-dimensional digital model of the joint portion from the plurality of two-dimensional medical images, the processor also configured to construct the three-dimensional digital model when the medical image data is sufficient to construct the three-dimensional digital model, the processor further configured to construct a patient-specific digital model of a patient-specific alignment guide when the medical image data is sufficient to construct the three-dimensional digital model, the patient-specific alignment guide having a three-dimensional surface that nests against a corresponding surface of the three-dimensional digital model of the joint portion; and
a display that displays the three-dimensional digital model of the joint portion and the patient specific digital model of the patient-specific alignment guide when the processor determines that the medical image data is sufficient for constructing the three-dimensional digital model of the joint portion, the display also displaying at least one of the two-dimensional medical images of the joint portion for selection of a non-custom implant when the processor determines that the medical image data is insufficient for constructing the patient-specific alignment guide therefrom.

20. A pre-operative planning and manufacturing method for orthopedic surgery of a knee joint of a patient comprising:
obtaining pre-operative medical image data representing the knee joint, the medical image data including a plurality of two-dimensional images of the knee joint;
constructing a three-dimensional digital model of the knee joint and manufacturing a patient-specific alignment guide for the knee joint from the three-dimensional digital model of the knee joint when the plurality of two-dimensional images of the knee joint is sufficient to construct the three-dimensional digital model of the knee joint, the patient-specific alignment guide having a three-dimensional patient-specific surface pre-operatively configured to nest and closely conform to a corresponding surface of the knee joint of the patient in only one position relative to the knee joint;
determining, based on at least one of the two-dimensional images of the knee joint, a size of a non-custom implant to be implanted in the knee joint of the patient when there is insufficient image data to construct the patient-specific alignment guide therefrom;
determining a dimension for a non-custom surgical instrument configured for implanting the non-custom implant when there is insufficient image data to construct the patient-specific alignment guide therefrom;
manufacturing at least one of the non-custom implant and the non-custom surgical instrument when there is insufficient image data to construct the patient-specific alignment guide therefrom; and
assembling a kit containing the non-custom implant and the non-custom surgical instrument when there is insufficient image data to construct the patient-specific alignment guide therefrom.